Prophylactic Pancreatic Duct Stenting in Acute Necrotizing Pancreatitis

NCT01767233 | Unknown DMC

• 1 other identifier: 36/2010
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Since the majority of patients with necrotizing pancreatitis will experience a leak from the pancreatic duct during their course of disease resulting in intra- and peripancreatic fluid collections, it is reasonable to hypothesize that placement of a ductal stent may prevent some of the late complications and morbidity associated with pancreatic necrosis. This prospective, randomized, controlled multicenter trial investigates the role of early prophylactic ductal stenting in acute necrotizing pancreatitis. The purpose of the study is to determinate the safety and feasibility of early prophylactic pancreatic duct stenting in necrotizing pancreatitis in reducing complications, length of stay in hospital and in in-tensive care unit compared to the traditional treatment.

Conditions

Acute Necrotizing Pancreatitis

Keywords

Acute necrotizing pancreatitis; ERCP; Pancreatic stenting

Outcome Measures

Primary Outcomes (1)

• The need for percutaneous, endoscopic, laparoscopic, or open surgical drainage and/or debridement after randomization.

  The indications for drainage/debridement are: 1. Infection 2. Gastro-intestinal or bile duct obstruction 3. Pain caused by pancreatic or peripancreatic collection(s) 4. Leakage of pancreatic juice (i.e. ascites or pleural fluid with an amylase content greater than 3 times the serum amylase activity)

  12 months

Study Arms (1)

Pancreatic stenting

EXPERIMENTAL

Pancreatic stenting versus observation

Procedure: ERCP and pancreatic stenting

Interventions

ERCP and pancreatic stenting PROCEDURE

Pancreatic stenting

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• In patients with suspected necrotizing pancreatitis a pancreatic protocol 3-phase contrast enhanced (CE) CT shall be performed. Since a very early CT may underestimate the extent of pancreatic necro-sis, it is recommended to wait at least 72 hours after the onset of symptoms before CT is done. The CECT may be repeated if the initial CT shows no necroses and the clinical course continues to indicate a severe case.
• MRI may be used instead of CT in case of contraindication to intravenous contrast due to renal failure.
• If CECT reveals pancreatic necrosis affecting the head, neck, or body of pancreas and the necrosis is suspected to include the main pancreatic duct an informed consent to participate in the study is ob-tained, after which the patient will be randomized to either a) the control group with traditional treat-ment (i.e. at the discretion of each participating center) or to b) the intervention group with same treatment as in the control group plus ERP and PD-stenting. Patients with isolated necrosis of the tail will not be included in the study.

You may not qualify if:

• All consecutive patients (age between 18-75 years) admitted to the participating centers for acute pan-creatitis with an area of non-enhancing pancreatic parenchyma on CT believed to represent necrosis are prospectively enrolled in the study. At initial presentation the age, gender, etiology of the pancreatitis, clinical and laboratory findings will be recorded. Patients with malignancies and patients from whom an informed consent to participate in the study cannot be obtained will be excluded.

Sponsors & Collaborators

• University of Oulu: lead
• Copenhagen University Hospital, Hvidovre: collaborator

Study Sites (1)

Oulu University Hospital

Oulu, Oulu, 90029, Finland

RECRUITING

Related Publications (1)

• Karjula H, Nordblad Schmidt P, Makela J, Liisanantti JH, Ohtonen P, Saarela A. Prophylactic pancreatic duct stenting in severe acute necrotizing pancreatitis: a prospective randomized study. Endoscopy. 2019 Nov;51(11):1027-1034. doi: 10.1055/a-0865-1960. Epub 2019 Mar 20.

  PMID: 30895583 DERIVED

MeSH Terms

Conditions

Pancreatitis, Acute Necrotizing

Interventions

Cholangiopancreatography, Endoscopic Retrograde

Condition Hierarchy (Ancestors)

Pancreatitis; Pancreatic Diseases; Digestive System Diseases

Intervention Hierarchy (Ancestors)

Cholangiography; Radiography, Abdominal; Radiography; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis; Diagnostic Techniques, Digestive System; Endoscopy, Digestive System; Endoscopy; Diagnostic Techniques, Surgical; Digestive System Surgical Procedures; Surgical Procedures, Operative; Minimally Invasive Surgical Procedures

Central Study Contacts

Heikki K Karjula, MD

CONTACT

+ 358 08 3152830; heikki.karjula@ppshp.fi

Arto O Saarela, PhD

CONTACT

+ 358 08 3152809; arto.saarela@ppshp.fi

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 10, 2013
• First Posted: January 14, 2013
• Study Start: January 1, 2011
• Primary Completion: December 1, 2014
• Study Completion: December 1, 2015
• Last Updated: January 14, 2013

Record last verified: 2013-01

Locations

FI (1)