Initial experience with pancreatic stent placement for the prophylaxis of post-ERCP pancreatitis (PEP)

Introduction and aim: PEP is the most common complication of ERCP with an incidence of 4–5% in unselected and more than 10% in high-risk patients. Prophylactic pancreas stenting is recently recommended to prevent PEP. The aim of this study was to evaluate our initial results with the placement of prophylactic pancreas stent.

Patients and methods: We started to insert prophylactic pancreas stents (5 F, 3cm) in cases of difficult biliary cannulation since 2009, and reviewed retrospectively the first 23 cases until March 2011. The mean age of the 17 female and 6 male patients was 61 years (35–87). Multiple pancreatic duct cannulation or repeated guidewire placement into the pancreatic duct indicated the insertion of prophylactic pancreas stent.

Results: Pancreatic guidewire assisted biliary cannulation was successful in 4 patients, biliary sphincterotomy was performed in these cases, and the pancreatic stent was inserted afterwards. Pancreas stent was inserted in all other cases before further intervention. Biliary sphincterotomy was possible in 7 cases after pancreatic stenting, while in 4 cases needle knife pre-cut papillotomy preceded the complete papillotomy. Only needle knife pre-cut papillotomy was possible in 6 patients during the initial ERCP, and the procedure was repeated after 3–6 days with successful completion of biliary sphincterotomy in all of these patients. None of the patient had severe pancreatitis, 1 patient (4.3%) had mild pancreatitis after the procedure. The pancreatic stents were removed endoscopically after an average of 4 days (2–9 days) in most cases, but in 3 patients they were removed only after 49, 91 and 148 days.

Conclusion: Prophylactic pancreas stent placement is a useful method in cases of difficult biliary cannulation, prevents severe PEP in high-risk patients and facilitates biliary cannulation and sphincterotomy in this patient group.