Technical factors associated with the benefit of prophylactic pancreatic stent placement during high-risk ERCP: a secondary analysis of the SVI trial dataset

Abstract

Background: Prophylactic pancreatic stent placement (PSP) is effective for preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high-risk cases, but the optimal technical approach to this intervention remains uncertain. Methods: In this secondary analysis of 787 clinical trial participants who underwent successful stent placement, we studied the impact of: 1) whether pancreatic wire access was achieved for the sole purpose of PSP or naturally during the conduct of the case; 2) the amount of effort expended on PSP; 3) stent length; 4) stent diameter; and 5) guidewire caliber. We used logistic regression models to examine the adjusted association between each technical factor and post-ERCP pancreatitis (PEP). Results: Ninety-one of the 787 patients experienced PEP. There was no clear association between PEP and whether pancreatic wire access was achieved for the sole purpose of PSP (vs. occurring naturally; OR 0.82, 95%CI 0.37-1.84), whether substantial effort expended on stent placement (vs. non-substantial effort; OR 1.58, 95%CI 0.73-3.45), stent length (>5 cm vs. ≤5 cm; OR 1.01, 95%CI 0.63-1.61), stent diameter (≥5 Fr vs. <5 Fr; OR 1.13, 95%CI 0.65-1.96), or guidewire caliber (0.035 inch vs. 0.025 inch; 0.83, 95%CI 0.49-1.41). Conclusions: The 5 modifiable technical factors studied in this secondary analysis of large-scale randomized trial data did not appear to have a strong impact on the benefit of prophylactic pancreatic stent placement in preventing PEP after high-risk ERCP. Within the limitations of post hoc subgroup analysis, these findings may have important implications in procedural decision-making and suggest that the benefit of PSP is robust to variations in technical approach.