Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-Fr pancreatic plastic stents placed with common-type guidewires: Results from a prospective multinational registry

the Pancreatic Stenting Registry Group

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background and Aim: Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods: High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results: One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty-one (76%) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions: Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

Original languageEnglish (US)
Pages (from-to)299-306
Number of pages8
JournalDigestive Endoscopy
Volume31
Issue number3
DOIs
StatePublished - May 2019

Bibliographical note

Funding Information:
A.R. IS A consultant for Boston Scientific. G.A.C. is a consultant for Boston Scientific and Olympus Corporation. H.N. receives research support from Boston Scientific, Cook Medical, ERBE, and CDx Diagnostics, and he is a consultant for Boston Scientific, Cook Medical, ERBE, and Olympus. H.N. also receives speaker’s fees from Boston Scientific, Cook Medical, ERBE, Olympus, the Falk Foundation, Fujifilm, and Medtronic. M.J.B. is a consultant for and receives research grants from Boston Scientific, Cook Medical, 3M, and Pentax Medical. R.K. receives research support from Boston Scientific and book royalties from Wiley-Blackwell, Springer, and Elsevier. T.B. is a consultant for Boston Scientific. J.W.P. is a consultant for Boston Scientific, Cook Endoscopy, and Pentax Medical. M.F. is a consultant for Boston Scientific and receives speaker’s fees from Cook Endoscopy. P.K. is a consultant for Boston Scientific. P.T. is a consultant for Boston Scientific. All other authors declare no conflicts of interest with respect to this work. This registry was sponsored by Boston Scientific Corporation and registered under number NCT02262845 in the USA and CTRI/2015/09/006194 in India.

Funding Information:
The following individuals contributed in meaningful ways to the research presented in this paper: The Pancreatic Stenting Registry Group membership consists of Nadav Sahar; Andrew Ross; Sundeep Lakhtakia; Gregory Cot?; Horst Neuhaus; Marco J. Bruno; Oleh Haluszka; Seng-Ian Gan (Virginia Mason Medical Center, Seattle, USA); Michael Gluck (Virginia Mason Medical Center, Seattle, USA); Shayan Irani (Virginia Mason Medical Center, Seattle, USA); Richard Kozarek; Michael Larsen (Virginia Mason Medical Center, Seattle, USA); Mohan Ramchandani; D. Nageshwar Reddy (Asian Institute of Gastroenterology, Hyderabad, India); Nicole Balasus (Evangelisches Krankenhaus D?sseldorf, D?sseldorf, Germany); Philipp Bender (Evangelisches Krankenhaus D?sseldorf, D?sseldorf, Germany); Torsten Beyna; Christian Gerges (Evangelisches Krankenhaus D?sseldorf, D?sseldorf, Germany); Jennis Kandler (Evangelisches Krankenhaus D?sseldorf, D?sseldorf, Germany); Andre Ragheb (Evangelisches Krankenhaus D?sseldorf, D?sseldorf, Germany); Paul Didden (Erasmus MC, University Medical Center, Rotterdam, The Netherlands); M.J.A.L. Grubben (Erasmus MC, University Medical Center, Rotterdam, The Netherlands); Arjun Koch (Erasmus MC, University Medical Center, Rotterdam, The Netherlands); Jan Poley; Jennifer Maranki; Kaveh Sharzehi (Temple University Health System, Philadelphia, USA); Martin Freeman; Prashant Kedia; and Paul Tarnasky. Christine Fazio, Matthew Rousseau and Joyce Peetermans, all employees of Boston Scientific Corporation, contributed to study design, planning and conduct, statistical analysis, and critical review of the manuscript.

Publisher Copyright:
© 2018 Japan Gastroenterological Endoscopy Society

Keywords

  • guidewire
  • pancreatography
  • plastic pancreatic stent
  • post-ERCP pancreatitis
  • stent migration

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