Impaired pancreatic drainage may be most important in the pathophysiology of postERCP pancreatitis. When there is a mechanical problem, there is often a mechanical solution. Pancreatic stenting reduces the incidence and severity of post-ERCP pancreatitis in highrisk patients. Young patients with suspected sphincter of Oddi dysfunction or prior pancreatitis and those undergoing procedures with either a difficult cannulation, precut and/or pancreatic sphincterotomy should be strongly considered for pancreatic stenting. Stents should be removed within about one week or have the proximal flaps removed to allow early spontaneous distal migration. Pancreatic stent placement following biliary intervention can occasionally be difficult. In cases where the primary goal is pancreatic therapy, one should consider establishing pancreatic access before addressing the bile duct. A pancreatic stent can then serve as a guide for sphincterotomy, but most importantly, protect against post-ERCP pancreatitis.
Paul R Tarnasky