Clinical Utility of Biodegradable Pancreatic Stents in a Tertiary UK Centre

Aims Pancreatic stents at ERCP have a proven role in reducing the risk of post-ERCP pancreatitis in high risk patients (eg. inadvertent pancreatic cannulation, ampullectomy, pancreatic endotherapy) and may also aid difficult biliary cannulation (ESGE guidelines). Standard non-biodegradable pancreatic stents carry risk (inward migration, strictures if left in place long term), and require careful imaging follow-up to confirm spontaneous migration (and/or planned endoscopic removal). Biodegradable stents may avoid these risks but maintain the clinical benefit of non-biodegradable stents. We report our experience of biodegradable pancreatic stents in a large UK tertiary hospital.

Methods The electronic medical record was searched for the terms “biodegradable”, “pancreatic” ' “Archimedes” between 2021 and 2024 in patients undergoing ERCP. Patients who opted out of medical research were excluded. The medical records were retrospectively reviewed. Data extracted included patient characteristics, procedure related information and outcomes.

Results Twenty-seven patients (mean age 58 years, 52% male) underwent ERCP with Archimedes (Q3 Medical) 6 cm 6 Fr biodegradable pancreatic stent placement. ERCP indications included common bile duct (CBD) stones (41%), pancreatic stones or strictures (41%), malignant biliary stricture (15%), and ampullectomy (4%). All patients received rectal NSAIDs. Indications for pancreatic stenting included unintentional pancreatic cannulation, with stent to reduce risk of pancreatitis/aid biliary cannulation (46%) or post-pancreatic endotherapy (54%). Technical success was 100%. No immediate stent-related complications occurred, but two patients developed mild post-ERCP pancreatitis (7.4%). In 7 patients who had follow-up imaging (between 1 and 7 months) no evidence of a biodegradable stent was seen.

Conclusions Biodegradable pancreatic stents were mainly used as prophylaxis to reduce the risk of post-ERCP pancreatitis in patients with increased risk. The stents appeared safe and effective. The use of non-biodegradable prophylactic pancreatic stents requires all patients to return for repeat X-ray to check for stent migration, and repeat endoscopy for stent removal is required in 20%. As well as direct clinical benefit, biodegradable stents may contribute to a greener endoscopy service and reduce the administrative burden of stent tracking that comes with non-biodegradable stents.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025