Endoscopy 2011; 43(4): 325-330
DOI: 10.1055/s-0030-1256305
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled trial

E.  Zolotarevsky1 , S.  M.  Fehmi1 , 2 , M.  A.  Anderson1 , P.  S.  Schoenfeld1 , B.  J.  Elmunzer1 , R.  S.  Kwon1 , C.  R.  Piraka1 , E.-J.  Wamsteker1 , J.  M.  Scheiman1 , S.  J.  Korsnes1 , D.  P.  Normolle1 , 3 , H.  Myra  Kim1 , G.  H.  Elta1
  • 1University of Michigan Medical Center, Ann Arbor, Michigan, USA
  • 2University of California, San Diego Medical Center, California, USA
  • 3University of Pittsburgh Medical Center, Pennsylvania, USA
Further Information

Publication History

submitted 22 May 2010

accepted after revision 11 October 2010

Publication Date:
31 March 2011 (online)

Background: Temporary prophylactic pancreatic duct stenting effectively reduces post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients, but the optimal stent remains unclear. We compared rate of spontaneous passage, and technical difficulty of placement for 3-Fr and 5-Fr stents.

Methods: A randomized controlled trial at a single academic medical center. Patients deemed high risk for PEP randomly received 5-Fr or 3-Fr pancreatic duct stents. Primary outcome was spontaneous stent passage by 2 weeks. Secondary outcomes were ease and time for stent placement, and number of guide wires required for the entire procedure.

Results: Patients (69 female [89 %]; mean age 44.9 years, standard deviation [SD] 16.8) were randomly assigned to receive 5-Fr (n = 38) and 3-Fr (n = 40) stents. Indications for stenting were similar. Seven patients in the 3-Fr group actually received a 5-Fr stent, and two in the 5-Fr group had a 3-Fr stent. Spontaneous passage or non-passage was confirmed in 64 (83 %). No statistically significant difference in spontaneous passage rates was seen (5-Fr group, 68.4 %; 3-Fr group 75.0 %; P = 0.617). Non-passage rates were 10.5 % (5-Fr group) and 10.0 % (3-Fr group) (P = 1.00). The study was stopped after a futility analysis for the primary end point. Placement of 5-Fr stents was rated easier, at a mean score of 1.8 (5-Fr) vs. 3.4 (3-Fr), P < 0.001, with a trend towards being faster, 9.2 vs. 11.1 minutes (P = 0.355). Fewer guide wires were required for 5-Fr stent placement, 1.5 vs. 1.9 (P = 0.002). PEP rates did not differ (P = 0.519).

Conclusion: Placement of 5-Fr compared to 3-Fr pancreatic duct stents for PEP prophylaxis is easier, faster, and requires fewer wires. No statistically significant difference in spontaneous passage was found between the two sizes.

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E. ZolotarevskyMD 

University of Michigan
Division of Gastroenterology

3912 Taubman Center Drive
1500 East Medical Center Drive
Ann Arbor, MI 48109

Fax: +1-734-936-7392

Email: ezolotar@med.umich.edu

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