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Enochsson, Lars
Publications (10 of 31) Show all publications
Soreide, J. A., Karlsen, L. N., Sandblom, G. & Enochsson, L. (2019). Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review. Surgical Endoscopy, 33(6), 1731-1748
Open this publication in new window or tab >>Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review
2019 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 33, no 6, p. 1731-1748Article, review/survey (Refereed) Published
Abstract [en]

Background: Endoscopic retrograde cholangiopancreatography (ERCP) was introduced more than four decades ago as a diagnostic tool for biliary and pancreatic diseases. Currently, ERCP is mainly used as a therapeutic approach to relieve biliary or pancreatic duct obstruction. Clinical practice has been based on a few large reports and some randomized controlled trials. These data are valuable and important, but the external validity of these reports is limited. Implementation into routine practice should be balanced with the knowledge that these studies were conducted under very specific circumstances. This review was undertaken to describe ERCP results from population-based national registries recorded during routine clinical practice.

Methods: A systematic literature search of the electronic databases Medline Ovid and Embase was conducted. Eligible papers were selected and data were recorded according to the PRISMA criteria.

Results: Thirty-one studies were included: 15 true national population-based and 16 population-level studies. Most studies originated from countries with a governmental public health care system. At least three-quarters of the ERCP procedures are currently therapeutic, and the technical success rate is high (>90%). The postprocedure 30-day mortality rate ranged between 1 and 5% and was strongly correlated with older age, male sex, emergency admission, and noncancer comorbidities, but exhibited a lower correlation with the annual ERCP volume. Patients with primary sclerosing cholangitis or liver cirrhosis should receive particular attention. The risk of developing a bile duct, liver, or pancreas malignancy after ERCP tended to increase, but endoscopic sphincterotomy did not affect this risk.

Conclusion: ERCP is currently mainly used as a therapeutic approach, and the results are generally likely to improve patients' conditions. A nationwide registry enables better monitoring of routine clinical practice. The collection of valuable information from routine clinical practice in population-based databases may help to improve patient care from best evidence to best practice.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
ERCP, National, Registry, Population-based, Outcomes
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-159587 (URN)10.1007/s00464-019-06734-w (DOI)000467688800004 ()30863927 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Noel, R., Arnelo, U., Lundell, L., Hammarqvist, F., Jumaa, H., Enochsson, L. & Sandblom, G. (2018). Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial. HPB, 20(10), 932-938
Open this publication in new window or tab >>Index versus delayed cholecystectomy in mild gallstone pancreatitis: results of a randomized controlled trial
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2018 (English)In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 20, no 10, p. 932-938Article in journal (Refereed) Published
Abstract [en]

Background: Delayed cholecystectomy is associated with increased risk of biliary events. The objectives of the study were to confirm the superiority of index cholecystectomy over delayed operation in mild gallstone pancreatitis.

Methods: Patients with mild gallstone pancreatitis were randomized into index-or delayed cholecystectomy (IC vs. DC). IC was performed within 48 h from randomization provided a stable or improved clinical condition. The primary outcome was gallstone-related events. Secondary outcomes were rates of cholecystectomy complications, common bile duct stones (CBDS) detected at cholecystectomy and patient reported quality-of-life and pain.

Results: Sixty-six patients were randomized into IC (n = 32) or DC (n = 34) between May 2009 and July 2017. There were significantly higher rates of gallstone-related events in the DC compared with the IC group (nine patients vs. one patient, p = 0.013). No statistically significant differences could be demonstrated in cholecystectomy complications (p = 0.605) and CBDS discovered during cholecystectomy (p = 0.302) between the groups. Pain and emotional well-being measured by SF-36 were improved significantly in the IC group at follow-up.

Conclusions: Delayed cholecystectomy in mild gallstone pancreatitis can no longer be recommended since it is associated with an increased risk for recurrent gallstone-related events and impaired patient's reported outcomes. Trial registration number: clinicaltrials.gov (ID: NCT02630433).

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-153716 (URN)10.1016/j.hpb.2018.03.016 (DOI)000445924800007 ()29703649 (PubMedID)
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Enochsson, L., Blohm, M., Sandblom, G., Jonas, E., Hallerbäck, B., Lundell, L. & Österberg, J. (2018). Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers. BMJ Open, 8(1), Article ID e019551.
Open this publication in new window or tab >>Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 1, article id e019551Article in journal (Refereed) Published
Abstract [en]

Objective: To analyse the completeness in GallRiks of the follow-up frequency in relation to the intraoperative and postoperative outcome.

Design: Population-based register study.

Setting: Data from the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (ERCP), GallRiks.

Population: All cholecystectomies and ERCPs recorded in GallRiks between 1 January 2006 and 31 December 2014.

Main outcome measures: Outcomes for intraprocedural as well as postprocedural adverse events between units with either a 30-day follow-up of AO% compared with those with a less frequent follow-up (<90%).

Results: Between 2006 and 2014, 162 212 cholecystectomies and ERCP procedures were registered in GallRiks. After the exclusion of non-index procedures and those with incomplete data 152 827 procedures remained for final analyses. In patients having a cholecystectomy, there were no differences regarding the adverse event rates, irrespective of the follow-up frequency. However, in the more complicated endoscopic ERCP procedures, the postoperative adverse event rates were significantly higher in those with a more frequent and complete 30-day follow-up (OR 1.92; 95% Cl 1.76 to 2.11).

Conclusions: Differences in the follow-up frequency in registries affect the reported outcomes as exemplified by the complicated endoscopic ERCP procedures. A high and complete follow-up rate shall serve as an additional quality indicator for surgical registries.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-148039 (URN)10.1136/bmjopen-2017-019551 (DOI)000431743500090 ()29362270 (PubMedID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-06-09Bibliographically approved
Wanjura, V., Szabo, E., Österberg, J., Ottosson, J., Enochsson, L. & Sandblom, G. (2018). Morbidity of cholecystectomy and gastric bypass in a national database. British Journal of Surgery, 105(1), 121-127
Open this publication in new window or tab >>Morbidity of cholecystectomy and gastric bypass in a national database
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 1, p. 121-127Article in journal (Refereed) Published
Abstract [en]

Background: There is a strong association between obesity and gallstones. However, there is no clear evidence regarding the optimal order of Roux-en-Y gastric bypass (RYGB) and cholecystectomy when both procedures are clinically indicated.

Methods: Based on cross-matched data from the Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks; 79 386 patients) and the Scandinavian Obesity Surgery Registry (SOReg; 36 098 patients) from 2007 to 2013, complication rates, reoperation rates and operation times related to the timing of RYGB and cholecystectomy were explored.

Results: There was a higher aggregate complication risk when cholecystectomy was performed after RYGB rather than before (odds ratio (OR) 1.35, 95 per cent c.i. 1.09 to 1.68; P=0.006). A complication after the first procedure independently increased the complication risk of the following procedure (OR 2.02, 1.44 to 2.85; P<0.001). Furthermore, there was an increased complication risk when cholecystectomy was performed at the same time as RYGB (OR 1.72, 1.14 to 2.60; P=0.010). Simultaneous cholecystectomy added 61.7 (95 per cent c.i. 56.1 to 67.4) min (P<0.001) to the duration of surgery.

Conclusion: Cholecystectomy should be performed before, not during or after, RYGB.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-143625 (URN)10.1002/bjs.10666 (DOI)000418390500014 ()29044465 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-06-09Bibliographically approved
Oussi, N., Loukas, C., Kjellin, A., Lahanas, V., Georgiou, K., Henningsohn, L., . . . Enochsson, L. (2018). Video analysis in basic skills training: a way to expand the value and use of BlackBox training?. Paper presented at INTEC, Stockholm, Sweden. [Enochsson, Lars] Umea Univ, Dept Surg & Perioperat Sci, Div Surg, S-97180 Umea, Sweden.. Surgical Endoscopy, 32(1), 87-95
Open this publication in new window or tab >>Video analysis in basic skills training: a way to expand the value and use of BlackBox training?
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2018 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 32, no 1, p. 87-95Article in journal (Refereed) Published
Abstract [en]

Background: Basic skills training in laparoscopic high-fidelity simulators (LHFS) improves laparoscopic skills. However, since LHFS are expensive, their availability is limited. The aim of this study was to assess whether automated video analysis of low-cost BlackBox laparoscopic training could provide an alternative to LHFS in basic skills training.

Methods: Medical students volunteered to participate during their surgical semester at the Karolinska University Hospital. After written informed consent, they performed two laparoscopic tasks (PEG-transfer and precision-cutting) on a BlackBox trainer. All tasks were videotaped and sent to MPLSC for automated video analysis, generating two parameters (Pl and Prtcl_tot) that assess the total motion activity. The students then carried out final tests on the MIST-VR simulator. This study was a European collaboration among two simulation centers, located in Sweden and Greece, within the framework of ACS-AEI.

Results: 31 students (19 females and 12 males), mean age of 26.2 +/- 0.8 years, participated in the study. However, since two of the students completed only one of the three MIST-VR tasks, they were excluded. The three MIST-VR scores showed significant positive correlations to both the Pl variable in the automated video analysis of the PEG-transfer (RSquare 0.48, P < 0.0001; 0.34, P = 0.0009; 0.45, P < 0.0001, respectively) as well as to the Prtcl_tot variable in that same exercise (RSquare 0.42, P = 0.0002; 0.29, P = 0.0024; 0.45, P < 0.0001). However, the correlations were exclusively shown in the group with less PC gaming experience as well as in the female group.

Conclusion: Automated video analysis provides accurate results in line with those of the validated MIST-VR. We believe that a more frequent use of automated video analysis could provide an extended value to cost-efficient laparoscopic BlackBox training. However, since there are gender-specific as well as PC gaming experience differences, this should be taken in account regarding the value of automated video analysis.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
BlackBox trainer, MIST-VR simulation, Virtual reality, Video analysis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-144969 (URN)10.1007/s00464-017-5641-7 (DOI)000422854700009 ()28664435 (PubMedID)
Conference
INTEC, Stockholm, Sweden. [Enochsson, Lars] Umea Univ, Dept Surg & Perioperat Sci, Div Surg, S-97180 Umea, Sweden.
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-06-09Bibliographically approved
Wanjura, V., Sandblom, G., Österberg, J., Enochsson, L., Ottosson, J. & Szabo, E. (2017). Cholecystectomy after gastric bypass: incidence and complications. Surgery for Obesity and Related Diseases, 13(6), 979-987
Open this publication in new window or tab >>Cholecystectomy after gastric bypass: incidence and complications
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2017 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 13, no 6, p. 979-987Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.

OBJECTIVES: To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.

SETTING: Nationwide Swedish multiregister study.

METHODS: The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.

RESULTS: The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P<.001); the ratio peaked at 11.4 (10.2-12.6, P<.001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P<.001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P<.001), including reoperation (odds ratio 3.84, 2.76-5.36; P<.001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.

CONCLUSION: Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal.

Keywords
Bariatric surgery, Cholecystectomy, Gallstone, Gastric bypass, Obesity
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-132456 (URN)10.1016/j.soard.2016.12.004 (DOI)000406080500014 ()28185764 (PubMedID)
Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-06-09Bibliographically approved
Haraldsson, E., Lundell, L., Swahn, F., Enochsson, L., Löhr, J. M. & Arnelo, U. (2017). Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study.. United European Gastroenterology journal, 5(4), 504-510
Open this publication in new window or tab >>Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study.
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2017 (English)In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 5, no 4, p. 504-510Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla.

OBJECTIVE: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience.

METHODS: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists.

RESULTS: Interobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59-0.72).

CONCLUSION: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.

Keywords
Duodenoscopy, endoscopic classification, endoscopic retrograde cholangio-pancreaticography, interobserver agreement, intraobserver agreement, papilla of Vater
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-147739 (URN)10.1177/2050640616674837 (DOI)28588881 (PubMedID)
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-06-09
Jaafar, G., Hammarqvist, F., Enochsson, L. & Sandblom, G. (2017). Patient-Related Risk Factors for Postoperative Infection After Cholecystectomy. World Journal of Surgery, 41(9), 2240-2244
Open this publication in new window or tab >>Patient-Related Risk Factors for Postoperative Infection After Cholecystectomy
2017 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 9, p. 2240-2244Article in journal (Refereed) Published
Abstract [en]

Background: The impact of patient-related risk factors on the incidence of postoperative infection after cholecystectomy is relatively unknown.

Aim: The aim of this study was to explore potential patient-related risk factors for surgical site infection (SSI) and septicaemia following cholecystectomy.

Materials and methods: All cholecystectomies registered in the Swedish national population-based register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006–2014 were identified. The study cohort was cross-matched with the Swedish National Patient Register in order to obtain data on patient history and postoperative infections. Simple and multiple logistic regression analyses were performed in order to assess the impact of various comorbidities on the risk for SSI and septicaemia.

Results: A total of 94,557 procedures were registered. A SSI was seen following 5300 procedures (5.6%), and septicaemia following 661 procedures (0.7%). There was a significantly increased risk for SSI in patients with connective tissue disease (odds ratio [OR] 1.404, 95% confidence interval [CI] 1.208–1.633), complicated diabetes (OR 1.435, CI 1.205–1.708), uncomplicated diabetes (OR 1.391, CI 1.264–1.530), chronic kidney disease (OR 1.788, CI 1.458–2.192), cirrhosis (OR 1.764, CI 1.268–2.454) and obesity (OR 1.630, CI 1.475–1.802). There was a significantly higher risk for septicaemia in patients with chronic kidney disease (OR 3.065, CI 2.120–4.430) or cirrhosis (OR 5.016, CI 3.019–8.336).

Conclusion and discussion: Certain comorbidities have an impact on the risk for postoperative infection after cholecystectomy, especially SSI. This should be taken into account when planning the procedure and when deciding on prophylactic antibiotic treatment.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-140964 (URN)10.1007/s00268-017-4029-0 (DOI)000407304900009 ()28634841 (PubMedID)
Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-06-09Bibliographically approved
Olsson, G., Arnelo, U., Swahn, F., Törnqvist, B., Lundell, L. & Enochsson, L. (2017). The H.O.U.S.E. classification: a novel endoscopic retrograde cholangiopancreatography (ERCP) complexity grading scale. BMC Gastroenterology, 17, Article ID 38.
Open this publication in new window or tab >>The H.O.U.S.E. classification: a novel endoscopic retrograde cholangiopancreatography (ERCP) complexity grading scale
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2017 (English)In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 17, article id 38Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging endoscopic procedure, harboring a wide range of complexities within every single investigation. Classifications of the complexity of ERCP have been presented, but do not include modern endoscopic treatment modalities. In order to be able to target resources and compare the results of different endoscopic centers, a new complexity grading system for ERCP is warranted. This study launches a new complexity grading scale for ERCP-the H.O.U.S.E.-classification.

METHODS: The medical record of every patient undergoing ERCP 2009-2011 at the Karolinska University Hospital was reviewed, regarding the complexity of the procedure, and categorized into one out of three-grades in the HOUSE classification system, and concomitantly graded according to the Cotton grading system. All ERCP-procedures were also registered in the Swedish registry for gallstone surgery and ERCP (GallRiks) and correlations between the grading systems and procedure related variables as well as outcomes were made.

RESULTS: Between 2009 and 2011, 2185 ERCPs were performed at the Karolinska University Hospital, Huddinge. One thousand nine hundred fifty-four of those were index-ERCPs. Another 23 patients were excluded due to lack of postoperative complication registrations, leaving 1931 ERCP procedures to be analyzed. The procedure times were 40 ± 0.7, 65 ± 1.5 and 106 ± 3.2 min, respectively (HOUSE 1-3). The corresponding pancreatitis rates were 3.4, 7.0 and 6.8% and the postoperative complication rates 11.1, 15.7 and 12.8%, respectively.

CONCLUSIONS: The HOUSE-classification is a novel grading scale for ERCP-complexity. The system can be implemented in clinical practice to allocate resources and allow the comparisons of results between different endoscopic centers. Further studies are warranted to further sharpen this instruments validitity and general clinical relevance.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Complications, ERCP, Pancreatitis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-132455 (URN)10.1186/s12876-017-0583-z (DOI)28274206 (PubMedID)
Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-06-09Bibliographically approved
Olsson, G., Lübbe, J., Arnelo, U., Jonas, E., Törnqvist, B., Lundell, L. & Enochsson, L. (2017). The impact of prophylactic pancreatic stenting on post-ERCP pancreatitis: a nationwide, register-based study. United European Gastroenterology journal, 5(1), 111-118
Open this publication in new window or tab >>The impact of prophylactic pancreatic stenting on post-ERCP pancreatitis: a nationwide, register-based study
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2017 (English)In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 5, no 1, p. 111-118Article in journal (Refereed) Published
Abstract [en]

Background and objectives: The role of prophylactic pancreatic stenting (PS) in preventing post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP) has yet to be determined. Most previous studies show beneficial effects in reducing PEP when prophylactic pancreatic stents are used, especially in high-risk ERCP procedures. The present study aimed to address the use of PS in a nationwide register-based study in which the primary outcome was the prophylactic effect of PS in reducing PEP.

Methods: All ERCP-procedures registered in the nationwide Swedish Registry for Gallstone Surgery and ERCP (GallRiks) between 2006 and 2014 were studied. The primary outcome was PEP but we also studied other peri- and postoperative complication rates.

Results: Data from 43,595 ERCP procedures were analyzed. In the subgroup of patients who received PS with a total diameter ≤ 5 Fr, the risk of PEP increased nearly four times compared to those who received PS with a total diameter of >5 Fr (OR 3.58; 95% CI 1.40–11.07). Furthermore, patients who received PS of >5 Fr and >5 cm had a significantly lower pancreatitis frequency compared to those with shorter stents of the same diameter (1.39% vs 15.79%; p = 0.0033).

Conclusions: PS with a diameter of >5 Fr and a length of >5 cm seems to have a better protective effect against PEP, compared to shorter and thinner stents. However, in the present version of GallRiks it is not possible to differentiate the exact type of pancreatic stent (apart from material, length and diameter) that has been introduced, so our conclusion must be interpreted with caution.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
ERCP, pancreatic stents, pancreatitis, complication rates, prophylaxis
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-132469 (URN)10.1177/2050640616645434 (DOI)000394842000014 ()28405329 (PubMedID)
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2018-06-09Bibliographically approved
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