Complications of prophylactic pancreatic stent insertion in patients with increased risk of post-ERCP Pancreatitis

Introduction: The most frequent complication of ERCP is post- ERCP pancreatitis (PEP), which occurs in 4 – 5% of the average risk patients but can be higher than 10% in high risk groups. Prophylactic pancreatic stent (PPS) insertion is recommended in high risk patient to prevent PEP. Inspite of PPS insertion PEP will develop is some cases. The aim of our study was to evaluate the complications of PPS insertion and to look for possible risk factors. Patients and methods: PPS insertion was carried out in 115 patients with increased risk for PEP between May 2009 and March 2015 in our tertiary referral center. The indication, finding of ERCP, detailed procedural data, pre- and postprocedural laboratory data, findings of imaging studies and other parameters were collected from the electronic medical records and analyzed. PEP was defined according to the Cotton criteria. Results: 74 female and 41 male patients with mean age of 63 years (13 – 89) underwent PPS insertion. Hyperamylasaemia was detected in 66 cases (57%), while PEP developed in 10 cases (8.7%), 2 of them were severe, one was moderate, the rest were mild. The risk factors of PEP were unsuccesful PPS insertion (p < 0.001), presence of juxtapapillary diverticulum (p < 0.001), and when stent dislodgement occurs within 24 hours (p = 0.07). The development of PEP after PPS insertion did not correlate with age and sex of the patients, opacification of pancreatic duct, absence of distal bile duct dilatation or precut papillotomy. Other complications of PPS were proximal stent migration into the pacreatic duct in one case, and mild pancreatitis 17 days after PPS insertion. Conclusions: PEP can develop after PPS insertion in some patients. The risk of this complication is associated with unsuccesful stent insertion, juxtapapillary diverticulum and early stent dislodgement. Proximal stent migration and stent occlusion are rare complications of PPS. The latter can be prevented by stent removal if spontaneous passage is not observed within 5 – 10 days after insertion.