Preventive pancreas stenting. Our results with prospectively collected data

Introduction: The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidency in the high risk population can even reach 40%.

Aim: To analyze the database of our working group.

Methods: We retrospectively analyzed our prospective database between 2009.05.01 and 2012.12.31. We inserted preventive pancreas stents (PPSs) in high risk patients (pts) during the ERCP procedure according to the ESGE guidelines (one of these criteria: papillectomy, known or suspected sphincter of Oddi (SO) dysfunction, pancreatic EST, precut biliary sphincterotomy, pancreatic guide wire-assisted biliary cannulation, endoscopic balloon sphincteroplasty, pancreatic intervention, SO dilatation, AND more than 2 criterias from these: female gender, previous pancreatitis, younger age, non-dilated extrahepatic bile ducts, absence of chronic pancreatitis, normal serum bilirubin, pancreatic injection, high number of cannulation attempts, failure to clear bile duct stones). We used small caliber (5 F), short length (3–5cm) soft PPSs. Our database were analyzed primarily for PEP according to the Cotton's citeria, and secondly for other PPS-related complications. We exclusively analyzed the data of cases with complications and attempted but failed stented pts.

Results: We tried to insert 110 PPSs out of 1320 ERCPs (8.3%). The PPS placement was successful in 96 cases (87%). In 14 pts we did not succeed to insert the PPS (11 in the first 55/20%/, and 3 from the second 55/5.4%/attempts). The overall PEP rate was 8.3% (8/96) when the PPS insertion was successful, but raised to 29% (4/14) when it was not. We had only two stent-related complications: dislodgement to the pancreas.

Conclusion: PPS placement is a safe and relatively easy intervention wich has a learning curve even in experienced hands. The PEP rate could be decreased at least to one third of the cases in high risk poulation, therefore it must be cost-effective also, but in case of failure of PPS placement higher incidence of PEP could be expected.