Prophylactic Pancreatic Stents: Benefit and Frequency of Downstream Spontaneous Migration

Abstract

Purpose: The first objective was to assess the benefit of Prophylactic Pancreatic Stent (PPS) in our high risk population and the frequency of spontaneous migration of PPS. Second objective was to identify any clinical or technical factors associated with spontaneous migration. Methods: We reviewed the charts and endoscopic records of all patients who received a PPS from 2002 to 2006. Data collected included gender, age, ERCP indication, procedure performed during ERCP, type of PPS, symptoms after the initial ERCP, spontaneous stent migration and the need for endoscopic removal. Patients were classified in 2 groups according to stent outcome; spontaneous migration or endoscopic removal, with a comparison for clinical and technical characteristics. Frequency and interval to demonstrate spontaneous dislodgment or to perform endoscopic removal were recorded. Results: From June 2002 to November 2006, we identified 152 PPS that were placed in 141 patients (99 women and 42 men). The average age was 48.7 years (range 19–87). Pancreatic sphincterotomy was the most common procedure performed with 71 cases. Stent average length was 3 cm. Seventeen patients (11.1%) had post-ERCP pancreatitis, with 3 severe episodes. Factors associated with higher rates of post-ERCP pancreatitis were younger age (P= 0.03) and pancreatic sphincterotomy of the major papilla (P= 0.06). Complete follow up data was not available in 6% of the patients. Spontaneous migration was demonstrated in 88 stents (63.3%). The remaining 51 stents (36.7%) were removed by endoscopy. No significant difference was observed between these 2 groups of patient. A trend for higher rates of spontaneous migration was noted in females (P= 0.06). The mean delay to demonstrate PS migration was 35 days (range 2–372). Endoscopic removal was performed after a mean of 55 days (range 6–1119). Conclusion: PPS placement in high risk patients reduces post-ERCP pancreatitis rate, however severe pancreatitis may still rarely occur. Spontaneous migration of PPS was observed in 63% of cases. This rate may be increased by the use of stents with smaller caliber. No clinical or technical factors were identified to help to predict in which situation spontaneous stent migration will occur, except a tendency for more spontaneous migration in women. Because of poor patient compliance, long delays for the stent assessment and removal were observed.