Post ERCP Pancreatitis: Differences in Outcomes Between Long and Short Pancreatic Duct Stents

Abstract

Objective: Post ERCP Pancreatitis (PEP) is one of the most common complications of ERCP (endoscopic retrograde cholangiopancreatography). Prophylactic pancreatic duct (PD) stent placement has been shown to reduce the incidence of PEP especially in high risk patients from 15.6% to 4.8% (1). However, there is no consensus on the type of PD stent. The purpose of our study was to evaluate the differences in the outcomes between long (>3 cm) and short (≤3 cm) Hobbs PD stents. Methods: It was a retrospective review of all ERCP procedures performed at Columbia University Medical Center NYC between 08/01/2006 to 10/01/2007. All the procedures were performed by one of the two experienced endoscopists (>5yrs of experience) with involvement of a trainee. Patient data was collected for: indications, risk factors for PEP, type and reason for PD stent, complications including PEP, and any mortality. PD stent was removed endoscopically if it was still in place on abdominal x-ray done 2 weeks post-ERCP. The data was analyzed with Student t-test, Chi-square and ANNOVA tests by using SPSS software version 15.0. Results: Out of total 753 ERCP procedures, 175 (23%) required either long or short prophylactic PD stent. Out of these 175 procedures, 13 (7.4%) developed PEP. The baseline characteristics including age, sex, indications, and risk factors for PEP were similar in both groups except precut sphincterotomy was done less in long PD stent group (10 vs. 14, p-value 0.039). The incidence of PEP as well as the need for repeat endoscopy to remove PD stent was less in long PD stent group (see table below). There was no procedure-related mortality in each group. Conclusion: Long PD stents (>3 cm) showed better outcomes as compared to short PD stents in preventing PEP and less need for endoscopic removal. However, further prospective trials are needed to confirm these findings.