Durability of plastic pancreatic stents in post-ERCP pancreatitis prophylaxis

Aims Plastic pancreatic stents are one of the most effective methods for decreasing the incidence of post-ERCP acute pancreatitis.

In our center, the stent is usually removed by gastroscopy one week after placement and without radiological control.

The aim of our study is to verify how many plastic pancreatic stents are absent in the endoscopy according to size and time after insertion, as well as finding the best strategy for their removal.

Methods Descriptive and retrospective study, including patients which received a post-ERCP acute pancreatitis prophylactic stent insertion between January 2014 and December 2022.

We are using an Advanix type plastic pancreatic stents from Boston Scientific. Length and caliber are at the endoscopist’s choice.

Results 84 plastic pancreatic stents were placed. Average age was 69.44 years, with a 63.09% being more than 65 years old and minimal male predominance (51.19%).

The data on the stent sizes used are shown in Figure 1, being the 4 Fr x 5 cm and 5 Fr x 5 cm stents the most frequently used. There were 2 cases in which it was not possible to know the stent size.

All data on stent permanence or absence according to the time passed until the endoscopy are shown in Figure 2. We can observe that the proportion of migrated plastic pancreatic stents increases after 15 days.

There were 13 stents not removed in our center because the patient came from another center, had a terminal oncologic disease or died. [1] [2] [3] [4]

There were no complications with the withdrawal endoscopy in any case.

Figure 3 shows data on the plastic pancreatic stents absence or permanence according to the time passed until the endoscopy and their caliber, showing that larger caliber stents remaining longer.

Conclusions According to our data, there is an inversely proportional relationship between stent caliber and the probability of migration, with larger caliber stents remaining longer and the proportion of migrated plastic pancreatic stents increasing after 15 days.

Our data suggest the need for regular endoscopic removal after radiological control, which can be deferred until 15 days later, when a higher proportion of migrated plastic pancreatic stents can be observed.

Studies of a larger scope are required to verify our results.

Publication History

Article published online:
15 April 2024

• References

• 1 Testoni PA.. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases. World J Gastroenterol 2007; 13 (45) 5971-8
• 2 Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, Pais WP, Antillon MR, Roy PK.. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc 2011; 73 (02) 275-82
• 3 Freeman ML.. Use of Prophylactic Pancreatic Stents for the Prevention of Post-ERCP Pancreatitis. Gastroenterol Hepatol (N Y) 2015; 11 (06) 420-2
• 4 Martínez Crespo JJ, Serrano Díaz L, Marín Bernabé CM.. Problems with a prophylactic non-expulsive pancreatic stent. Rev Esp Enferm Dig 2020; 112 (11) 888-889