Temporary placement of small caliber prophylactic pancreatic stents to prevent post-ERCP pancreatitis in high risk patients – A single center experiences

Background: Post endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis is the most common complication of ERCP, which can occasionally become serious or fatal. The aim of the present study was to prospectively evaluate the efficacy of a temporary placement of small caliber prophylactic pancreatic duct (PD) stents to prevent post-ERCP pancreatitis in our endoscopy unit.

Methods: During the last two years prophylactic PD stents were successfully placed during initial ERCP in a total of 65 patients with high risk of pos-ERCP pancreatitis. The most common indications of prophylactic PD stenting were suspected sphincter of Oddi dysfunction, previous post-ERCP pancreatitis or idiopathic acute pancreatitis in the case history, and difficult or prolonged cannulation procedures. We usually applied 3–5cm long, 4–5 F Geenen prophylactic stents with inner and outer flags (Wilson-Cook). After 3–5 days post-procedure all PD stents were successfully removed during gastroscopy with a polypectomy snare. Complications were determined according to the Cotton consensus criteria.

Results: Placement of the prophylactic PD stent was successful and without complications in all 65 patients. The overall rates of mild, moderate and severe post-ERCP pancreatitis diagnosed were: 6,1%, 3,0% and 0%, respectively. Spontaneous dislodgement occurred within 48 hours in only 5 patients (7,7%), but more importantly in two out of these 5 patients (40%) a moderate post-ERCP pancreatitis developed. No correlation between the length or diameter of the prophylactic stents and the development of complications were detected. With the liberated prophylactic PD stent application no severe post-ERCP pancreatitis developed in our endoscopy unit out of 1800 consecutive ERCP procedures.

Conclusions: Placement of prophylactic PD stents at the time of the initial ERCP is useful and strongly proposed to prevent post-ERCP pancreatitis in high risk settings. Early spontaneous dislodgement may increase the risk of development of complications.