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CC BY 4.0 · Endosc Int Open 2026; 14: a28034865
DOI: 10.1055/a-2803-4865
Original article

Groove area involvement predicts post-ERCP pancreatitis after 8-mm fully-covered metal stent placement in resectable pancreatic cancer

Autor*innen

  • Shinya Kawaguchi 

    1   Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

  • Eiji Nakatani

    2   Department of Biostatistics and Health Data Science, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan

  • Tatsunori Satoh 

    1   Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

  • Shodai Takeda

    1   Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

  • Yuichi Masui

    1   Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

  • Shinya Endo

    1   Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

  • Hideyuki Kanemoto

    3   Surgery, Shizuoka General Hospital, Shizuoka, Japan
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Abstract

Background and study aims

Fully covered self-expandable metal stents (FCSEMSs) provide durable preoperative biliary drainage in pancreatic cancer but may increase risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). We evaluated whether groove involvement was an independent anatomical PEP risk factor and compared PEP incidence after 8-mm FCSEMS and plastic stent (PS) placement using propensity-score–based inverse probability of treatment weighting (IPTW).

Patients and methods

Sixty-two consecutive patients with resectable or borderline resectable pancreatic cancer and distal biliary strictures with naïve papillae underwent ERCPs between February 2015 and August 2024. An 8-mm FCSEMS or PS (7–11.5F) was placed. Independent PEP predictors were identified using multivariable Firth logistic regression. PEP incidence was compared between stent types after IPTW adjustment for age, sex, clinical stage, groove involvement, main pancreatic duct diameter, and prophylactic pancreatic-stent placement.

Results

Mean age was 73.3 ± 8.2 years (62.9% male). Groove-area extension was present in 21.0% of tumors. PEP occurred in six patients (9.7%), all after FCSEMS placement. Groove involvement independently predicted PEP (adjusted odds ratio, 14.7; 95% confidence interval, 2.26–95.9; P = 0.005). After IPTW, the weighted PEP rate remained higher with FCSEMS than PS (13.4% vs 0%; P = 0.011).

Conclusions

Groove-area tumor extension is an independent imaging-detectable PEP risk factor. Even after baseline difference adjustment, 8-mm FCSEMS placement was associated with a higher pancreatitis risk than PS placement. Pre-procedural groove involvement identification may guide stent selection and support selective prophylactic pancreatic stenting. However, further confirmation through larger prospective studies is required.

Keywords

Pancreatobiliary (ERCP/PTCD) - Strictures - ERC topics

Supplementary Material



Publikationsverlauf

Eingereicht: 17. August 2025

Angenommen nach Revision: 02. Februar 2026

Accepted Manuscript online:
03. Februar 2026

Artikel online veröffentlicht:
26. Februar 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Shinya Kawaguchi, Eiji Nakatani, Tatsunori Satoh, Shodai Takeda, Yuichi Masui, Shinya Endo, Hideyuki Kanemoto. Groove area involvement predicts post-ERCP pancreatitis after 8-mm fully-covered metal stent placement in resectable pancreatic cancer. Endosc Int Open 2026; 14: a28034865.
DOI: 10.1055/a-2803-4865
 

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