We encountered 4 patients with acute pancreatitis (AP) of various etiologies and coexisting acute cholangitis who underwent endoscopic biliary stenting (EBS) and nasopancreatic drainage (NPD) via endoscopic retrograde cholangiopancreatography (ERCP) during the early phase of AP. ERCP is performed to treat acute cholangitis even in the context of AP. However, in difficult cases, accidental contrast media injection or guidewire insertion into the pancreatic duct can happen during ERCP for the purpose of EBS. It is concerned that cannulation injury and increased pancreatic duct pressure can exacerbate existing AP. Because pancreatic guidewire-associated techniques were required for all of them due to difficult biliary cannulation, we performed a NPD catheter placement using the pancreatic guidewire to decompress the pancreatic duct to prevent further exacerbating AP. Surprisingly, all patients dramatically improved without systemic or local complications. NPD could be performed without any adverse events and did not worsen the course of AP. Early decompression of a pancreatic duct using NPD may rather improve AP that had already developed. Further prospective research is needed to confirm our observations.
Case Rep Gastroenterol 2021;15:801–809

中文翻译：

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急性胰腺炎早期鼻胰引流4例

我们遇到了 4 名患有各种病因的急性胰腺炎 (AP) 并合并急性胆管炎的患者，他们在 AP 的早期阶段通过内镜逆行胰胆管造影术 (ERCP) 接受了内镜胆道支架术 (EBS) 和鼻胰腺引流术 (NPD)。即使在 AP 的情况下，ERCP 也用于治疗急性胆管炎。然而，在困难的情况下，为了 EBS 的目的，在 ERCP 期间可能会发生意外的造影剂注射或导丝插入胰管。人们担心插管损伤和胰管压力增加会加剧现有的 AP。由于胆管插管困难，所有患者都需要胰腺导丝相关技术，我们使用胰腺导丝进行 NPD 导管放置，以减轻胰管的压力，以防止 AP 进一步恶化。令人惊讶的是，所有患者都显着改善，没有全身或局部并发症。NPD 可以在没有任何不良事件的情况下进行，并且不会恶化 AP 的进程。使用 NPD 对胰管进行早期减压可能会改善已经发生的 AP。需要进一步的前瞻性研究来证实我们的观察结果。
Case Rep Gastroenterol 2021；15:801–809