Timing of Pancreatic Stent Placement May Impact Post-ERCP Pancreatitis Risk

Placement of pancreatic stents during ERCP reduces post-ERCP pancreatitis risk in higher-risk patients. However, there is no standard right time intraprocedurally to place the stent. A pancreatic stent can be placed earlier in the procedure (eg, as soon as there is pancreatic guidewire access) or later, just prior to ERCP conclusion.

In this retrospective single-center study, patients were divided into 2 groups: early pancreatic stent placement (EPSP) and late pancreatic stent placement (LPSP). The study did not clearly define early placement timing, but it appeared to occur in the middle of the procedure, nearly always just before sphincterotomy; LPSP timing was defined as the stent being placed at the procedure conclusion (after all therapy was complete). Patients received rectal nonsteroidal anti-inflammatory drugs at endoscopists’ discretion, and all patients received aggressive hydration with Lactated Ringer’s solution. All patients were admitted to the hospital to be monitored for adverse events, with routine measurement of serum amylase at 24 hours.

The investigators identified 590 patients (EPSP, 385; LPSP, 205) as having undergone ERCP with pancreatic stent placement over nearly 6 years. Post-ERCP pancreatitis occurred in significantly fewer patients in the EPSP group than in the LPSP group (2.9% vs 7.3%; odds ratio, 0.37; 95% confidence interval, 0.17-0.83), which remained significant when adjusting for confounders in multivariate analysis.