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Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry
Author(s) -
Sahar Nadav,
Ross Andrew,
Lakhtakia Sundeep,
Coté Gregory A.,
Neuhaus Horst,
Bruno Marco J.,
Haluszka Oleh,
Kozarek Richard,
Ramchandani Mohan,
Beyna Torsten,
Poley Jan W.,
Maranki Jennifer,
Freeman Martin,
Kedia Prashant,
Tarnasky Paul
Publication year - 2019
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13311
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , pancreatitis , stent , surgery , pancreatic duct , prospective cohort study
Background and Aim Pancreatic plastic stents ( PPS ) can reduce the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis ( PEP ). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4‐Fr stent designed to be deployed over a 0.035‐inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods High‐ PEP ‐risk patients received a 4‐Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty‐one (76%) PPS were placed using a 0.035‐inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP . Seventy‐eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent‐induced ductal trauma. Post‐hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions Among high‐risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4‐Fr pancreatic duct stents compatible with a 0.035‐inch guidewire. This low rate is not unequivocally due to the prophylactic stent.