Endoscopic Procedures Research Articles

Does type of anesthesia during procedural management of suspected renal colic during pregnancy have an impact on preterm birth?

Anesthesia choice during the procedural management of suspected renal colic during pregnancy may vary based on available resources and patient or provider preferences, as there are no specific recommendations. Our objective was to evaluate whether preterm birth (<37 weeks) was associated with anesthesia type, anesthesia timing by trimester, or procedure type. We retrospectively identified pregnant patients who required procedural management with ureteral stent, percutaneous nephrostomy (PCN), or ureteroscopy (URS) for suspected renal colic based on laboratory and imaging findings from 2009-2021 at our center. Analyzed data included anesthesia type (local analgesia only, monitored anesthesia care [MAC], spinal anesthesia, or general anesthesia), trimester of procedure, procedure type, and obstetric outcomes including preterm birth. The study cohort included 96 patients who underwent 231 total procedures, including primary URS, PCN, stent, as well as PCN and stent change. The median gestational age was 38.7 (37.1-39.5) weeks, and preterm birth rate was 15.8%. The most common anesthetic used across all procedures and trimesters was MAC. PCN was associated with the use of less invasive analgesia or anesthesia, whereas endoscopic procedures were more commonly performed with spinal or general anesthesia. Using multivariable logistic regression, procedure type was associated with preterm birth, but not anesthesia type or timing by trimester. Anesthesia type and timing were not associated with preterm birth, and selection may be influenced by resources, clinical scenario, or patient and provider preferences.

Analysis of 15 children with type Ⅳ branchial cleft cyst treated with endoscopic transoral approach

Objective: To analyze the clinical characteristics and endoscopic surgical procedures of the second branchial cleft cyst type Ⅳ in children. Methods: A retrospective review was conducted on 15 pediatric cases with type Ⅳ second branchial cleft cysts treated at the Beijing Children's Hospital affiliated with Capital Medical University and Henan Children's Hospital from September 2019 to November 2023. All patients underwent excision via a two-person, three-hand endoscopic transoral approach. The cohort included 12 males and 3 females, with an age range of 10 months to 10 years and 5 months, and a median age of (59.20±32.05) months. The clinical data of initial symptoms, sides, imaging features, treatment methods, complications, length of hospital stay, prognosis and outcome were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: Of the 15 children, 13 cases presented with snoring as the primary symptom, 1 case with dysphagia, and 1 case was asymptomatic and was found unintentionally. The mean disease duration was (6.74±9.05) months (range, from 3 days-2 years). MRI revealed cystic lesions on the right side in 12 cases and on the left side in 3 cases, characterized by uniform long T2 signal, equal T1 or short T1 signal. The cysts appeared dumbbell-shaped in 10 cases with the pharyngeal constrictor muscle as the waist, the posterior outside of the mass was adjacent to the internal carotid artery. The remaining 5 cases showed an isolated cyst located inside the pharyngeal constrictor muscle. The intraoperative MRI findings were consistent. Partial cystectomy was performed in 10 cases near the internal carotid artery, leaving only the portion with a clear arterial pulse intact. Five cases with isolated cysts on the medial side of the pharyngeal constrictor muscle were totally removed. The average length of hospital stay was (4.53±0.52) days (4-5 days). All patients were followed up for 7-56 months [median (30±15.12) months] with no recurrence of symptoms observed. Conclusions: The second branchial cleft cyst type Ⅳ in children is characterized by prominent pharyngeal cystic mass, with snoring as a predominant initial symptom, MRI provides excellent diagnostic value. The two-person, third-hand endoscopic transoral approach for cyst excision is feasible, safe, and offers the benefits of minimal invasiveness and reduced hospitalization time.

Association of Crohn’s Disease and Hepatic Cirrhosis Post-Primary Sclerosing Cholangitis: A Case Report

Primary sclerosing cholangitis (PSC) is a distinct entity associated with inflammatory bowel disease (IBD). We report the case of a 49-year-old patient with ileocecal Crohn’s disease of the stenosing phenotype, presenting with perianal lesions in the form of fistulas, who was diagnosed with PSC complicated by hepatic cirrhosis following the development of clinical and biological cholestasis, as well as his first ascitic decompensation. After initiating treatment with azathioprine for Crohn's, he experienced significant abdominal pain, ascites, and jaundice, leading to further investigations. MRI revealed bile duct stenosis, and endoscopic procedures confirmed portal hypertension. After excluding secondary causes, a diagnosis of PSC was made. Treatment with methotrexate and ursodeoxycholic acid resulted in clinical improvement. The discussion emphasizes the rare but notable association between Crohn's disease and PSC, outlining diagnostic challenges and management strategies. It highlights the poor prognosis linked to PSC, including risks of cirrhosis and colorectal cancer, with recommendations for regular monitoring and surveillance for dysplasia in patients with both conditions. Overall, the study underscores the need for careful management and ongoing research into effective treatments for this challenging dual diagnosis.

Original articleAbdominal pelvic radiotherapy prolongs surgical time of retrograde endoscopic treatment of upper urinary tract stones

Objective: the main objective is to assess whether urolithiasis diagnosed in patients with previous APRT need more endoscopic procedures to reach stone-free status and if these procedures are longer. The secondary objective is to find out if these patients have more complications resulting from endourologic procedures. Design and methodology: we designed a case-control unicentric study including patients with upper urinary tract lithiasis treated with retrograde ureterorenoscopy (URS) between 2006 and 2022. Case patients have previous history of APRT, while controls are patients without this history. We collected epidemiological, lithiasis and treatment related information in both groups. Results: we identified 18 upper urinary tract stones in cases that underwent endoscopic retrograde treatment. We linked these urinary stones with 18 urolithiasis diagnosed in control patients. The average age in patients and the diameter of the stones diagnosed were very similar in both groups, as well as the stones’ location. Longer surgical time was found for lithiasis treatment in case patients (129.6 versus 80.2 minutes in controls, p = 0.025). No significant differences were found regarding the rest of variables. Limitations: this is a retrospective and observational study, and the sample size is small, so we need to expand to a multicentric study. Originality and value: to our best knowledge this is the first study to provide data on how APRT may affect the effectiveness of endourological treatment of urolithiasis. Conclusion: endourological procedures for treatment of upper urinary tract stones in patients with previous APRT are longer than in patients without this background.

Open laryngotracheal reconstruction for iatrogenic posterior glottic stenosis in adults: international multicenter experience.

Posterior glottic stenosis (PGS) has a significant impact on breathing and quality of life, and remains a challenging condition to manage. Literature does not provide a single optimal approach. In this study we aim to assess post-operative outcomes of adult patients with acquired PGS treated with open laryngotracheal reconstruction (LTR) with autologous or cadaveric rib grafting. This multicenter retrospective cohort study included adults who underwent open LTR for iatrogenic PGS (2015-2023) and were followed for 26 months on average. Data on comorbidities, surgical complications, and interventions following surgery were collected. Forty-three adult patients were included. Decannulation was successful in 76.7%, and 53.5% of patients required an endoscopic or open revision procedure for recurrent stenosis during the mean post-operative follow-up of 26 months. Patients with severe obesity (BMI ≥ 35), moderate to severe co-morbidity (ASA ≥ 3) or Chronic Kidney Disease were significantly more likely to fail decannulation after LTR. Diabetes Mellitus and ASA ≥ 3 were significant negative predictors for intervention-free survival. There were no significant differences in decannulation rate or intervention free survival between patients that had LTR with autologous (n = 26) versus cadaveric (n = 17) cartilaginous grafting. This study describes the largest consecutive multicenter cohort of adult PGS patients treated with open LTR. This technique significantly improves breathing outcomes in PGS, with minimal complications in selected patients with a healthy weight and few comorbidities. Patients with a BMI ≥ 35, ASA ≥ 3, Diabetes Mellitus or renal failure have less favorable outcomes, with respect to decannulation rates and intervention-free survival.

Safety of edoxaban for delayed bleeding in gastrointestinal endoscopic procedures with a high risk of bleeding.

There are limited reports on the safety of gastrointestinal endoscopic procedures in individuals taking edoxaban, one of the direct oral anticoagulants. We clarified the incidence of delayed bleeding in patients who were on edoxaban in the perioperative period of gastrointestinal endoscopic procedures with a high risk of bleeding. This was an investigator-initiated, single-center, open-label, prospective, single-arm study. Patients on warfarin or edoxaban undergoing endoscopy with a high risk of bleeding were enrolled from June 2018 to September 2021. Warfarin was replaced with edoxaban in patients on warfarin. Patients taking other direct oral anticoagulants, and antiplatelet drugs, were excluded. The primary endpoint was severe delayed bleeding (Common Terminology Criteria for Adverse Events [CTCAE] grades III-V) and the secondary endpoints included thromboembolism, all adverse events, any delayed bleeding (CTCAE grades I or II), and hospital stay durations. Twenty-one patients on edoxaban underwent high-risk endoscopy. Three cases (14%) experienced CTCAE grade III delayed bleeding, requiring endoscopic hemostasis. No CTCAE grade I-II delayed bleeding or thromboembolic events occurred. Cholangitis and aspiration pneumonia (conservatively treated) occurred during the hospital stay. The median length of hospital stay was 8 days (range 3-24 days). Patients with delayed bleeding had higher systolic blood pressure at admission and longer hospital stays. The delayed bleeding incidence in high-risk endoscopic procedures for patients on edoxaban was acceptable. Higher blood pressure may be associated with increased risk, but further research is needed.

Rates and risk factors of bleeding after gastric endoscopic submucosal dissection with continuous warfarin or 1-day withdrawal of direct oral anticoagulants.

The 2017 Japanese guidelines recommend continuing warfarin therapy during the perioperative period or discontinuing direct oral anticoagulants (DOACs) only on the day of endoscopic submucosal dissection for early gastric cancer. However, their safety has not been sufficiently explored. This study aimed to validate this management method. This retrospective, multicenter study analyzed the characteristics and outcomes of patients who underwent gastric endoscopic submucosal dissection between July 2017 and June 2019. The patients were categorized according to the use of warfarin or DOACs. Among the 62 eligible patients, 53 (85%) were male (median age, 76years). Warfarin was used in 10 patients (16%) and DOACs in 52 patients (84%). Fourteen patients taking DOACs (27%) used concomitant antiplatelet agents, with seven patients (13%) continuing treatment at the time of the endoscopic procedure. No postprocedural bleeding occurred in patients receiving warfarin (0%), whereas 10 cases (19%) of bleeding occurred in patients receiving DOACs: rivaroxaban, 0% (0/22); dabigatran, 0% (0/2); edoxaban, 43% (6/14); and apixaban, 29% (4/14). The type of anticoagulant (P<0.01) and continuation of antiplatelet therapy (P=0.02) were risk factors for postprocedural bleeding in patients receiving DOACs. Intraprocedural bleeding requiring transfusion or symptomatic thromboembolic events were not reported. Continuous warfarin therapy is preferred. DOAC withdrawal 1day before a procedure is associated with a high bleeding rate, which may differ for different types of anticoagulants. The continuation of antiplatelet medications in patients receiving DOACs carries a high risk of bleeding and is a future challenge.

Peroral endoscopic myotomy for sigmoid-type achalasia after Heller myotomy and endoscopic submucosal dissection for an early esophageal cancer in a single endoscopic procedure.

Peroral endoscopic myotomy for sigmoid-type achalasia after Heller myotomy and endoscopic submucosal dissection for an early esophageal cancer in a single endoscopic procedure.

S928 Long-Term Follow Up Data from a Prospective Quality Improvement Intervention for the Prevention of Corneal Abrasions During Endoscopic Procedures in the Post-COVID-19 Era

S928 Long-Term Follow Up Data from a Prospective Quality Improvement Intervention for the Prevention of Corneal Abrasions During Endoscopic Procedures in the Post-COVID-19 Era

S922 Decrease Risk of Intubation and Aspiration Pneumonia Associated with Endoscopic Procedure Among Patients on Glucagon-Like Peptide 1 Receptor Agonists

S922 Decrease Risk of Intubation and Aspiration Pneumonia Associated with Endoscopic Procedure Among Patients on Glucagon-Like Peptide 1 Receptor Agonists

Comprehensive audit of gastrointestinal endoscopy adverse events: Emphasizing quality indicators and economic impact with the AIG-AGREE modification.

Background and study aims: This study aimed to conduct a clinical audit of adverse events (AEs) arising from gastrointestinal endoscopy, utilizing the AGREE classification for AEs and establishing its correlation with the ASGE classification. This study further integrated the economic repercussions of AEs into the AGREE classification through the AIG-AGREE modification. Patients and methods: A prospective observational study was conducted at the Asian Institute of Gastroenterology, Hyderabad, India, from July 1, 2021, to December 31, 2021. The study included all patients who underwent diagnostic or therapeutic endoscopic procedures. AEs were categorized using the American Society of Gastrointestinal Endoscopy (ASGE) and AGREE classifications. A quality indicator questionnaire containing 15 questions was graded based on the latest ASGE and European Society of Gastrointestinal Endoscopy guidelines. The grading scale ranged from 1 to 3 (poor), 4 to 6 (average), 7 to 9 (excellent), to 10 (outstanding). In addition, the AIG-AGREE modification divided the economic impact into five scales (α, β, γ, δ, and ε) based on multiples of the baseline amount. (ClinicalTrials.gov Identifier: NCT05228353) Results: Over the 6-month study period, a total of 42,471 endoscopic procedures were performed, identifying 220 AEs. Analysis revealed a significant positive correlation (Pearson correlation coefficient = 0.79; P < 0.001) between the grades of AEs in the AGREE and ASGE classifications. The median score for all quality indicators was 8, indicating excellent services based on feedback from 13,042 surveyed patients. Notably, patients with more severe AEs (AGREE III-V) exhibited higher economic impact categories (β, γ, δ, ε) compared with those with less severe AEs (AGREE I-II). Conclusions: The AIG-AGREE modification stands as a pioneering effort that highlights the importance of considering economic factors in the evaluation of AEs in gastrointestinal endoscopy.

Antibiotic prophylaxis in digestive endoscopy: Guidelines from the French Society of Digestive Endoscopy

AbstractDigestive endoscopy is a highly dynamic medical discipline, with the recent adoption of new endoscopic procedures. However, comprehensive guidelines on the role of antibiotic prophylaxis in these new procedures have been lacking for many years. The Guidelines Commission of the French Society of Digestive Endoscopy (SFED) convened in 2023 to establish guidelines on antibiotic prophylaxis in digestive endoscopy for all digestive endoscopic procedures, based on literature data up to September 1, 2023. This article summarizes these new guidelines and describes the literature review that fed into them.

Efficacy of novel endoscopic hemostatic agent for bleeding control and prevention: Results from a prospective, multicenter national registry.

Background and study aims Topical hemostatic agents emerged as a new treatment modality for gastrointestinal bleeding. The aim of this study was to assess the safety and efficacy of PuraStat for control of active bleeding and for prevention of bleeding after different operative endoscopy procedures. Patients and methods A national, multicenter, observational registry was established to collect data from ten Italian centers from June 2021 to February 2023. Demographics, type of application (active gastrointestinal bleeding or prevention after endoscopic procedures, site, amount of gel used, completeness of coverage of the treated area), outcomes (rates of intraprocedural hemostasis and bleeding events during 30-day follow-up), and adverse events (AEs) were prospectively analyzed. Results Four hundred and one patients were treated for active gastrointestinal bleeding or as a preventive measure after different types of operative endoscopy procedures. Ninety-one treatments for active bleeding and 310 preventive applications were included. In 174 of 401 cases (43.4%), PuraStat was the primary treatment modality. Complete coverage was possible in 330 of 401 (82.3%) with difficulty in application in seven of 401 cases (1.7%). Hemostasis of active bleedings was achieved in 90 of 91 patients (98.9%). In 30-day follow-up 3.9% patients in whom PuraStat was used for prophylaxis had a bleeding event compared with 7.7% after hemostasis. No AEs related to the use of PuraStat were reported. Conclusions PuraStat is a safe and effective hemostat both for bleeding control and for bleeding prevention after different operative endoscopy procedures. Our results suggest that the possible applications for the use of PuraStat may be wider compared with current indications.

Endoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis.

Background and study aims: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for gastrointestinal lesions. It carries potential risks such as bleeding and perforation. This meta-analysis was conducted to assess the safety, effectiveness, and feasibility of endoscopic suturing, a promising technique for closing mucosal defects post-ESD. Methods: We reviewed several databases, including MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase up to May 1,2023. We aimed at identifying original studies that provided insightful data on the use of endoscopic suturing in reducing complications post-ESD. Results: In our study, we evaluated 426 publications and included 10 studies involving a total of 284 patients. The pooled technical success rate of endoscopic suturing was 92.6% (95% confidence interval [CI] 0.88-0.96). The pooled rate for sustained closure of mucosal defects post-endoscopic submucosal dissection (ESD) was estimated to be 80.7% (95% CI 0.71-0.88). The pooled mean time required to perform the endoscopic suturing procedure was calculated to be 31.11 minutes (95% CI 16.01-46.21). Among the studies reviewed for the incidence of delayed perforation post-ESD, a singular event of perforation was documented, suggesting a minimal occurrence. The overall rate of delayed bleeding was 5.3% (95% CI 0.30-0.10). Within the subset of patients using antithrombotic drugs, our subgroup analysis identified a delayed bleeding event rate of 6.7% (95% CI 0.02-0.25). Conclusions: Our results underscore the potential of endoscopic suturing as a viable and efficient technique in managing mucosal defects following ESD, highlighting the need for further large, prospective research to corroborate these findings and concentrate on establishing standard methodologies.

Rapid On-Site Histology of Lung and Pleural Biopsies Using Higher Harmonic Generation Microscopy and Artificial Intelligence Analysis

Lung cancer is one of the most prevalent and lethal cancers. To improve health outcomes while reducing health care burden, it becomes crucial to move toward early detection and cost-effective workflows. Currently, there is no method for the on-site rapid histologic feedback on biopsies taken in diagnostic, endoscopic, or surgical procedures. Higher harmonic generation (HHG) microscopy is a laser-based technique that provides images of unprocessed tissue. In this study, we report the feasibility of an HHG portable microscope in the clinical workflow in terms of acquisition time, image quality, and diagnostic accuracy in suspected pulmonary and pleural malignancy. One hundred nine biopsies of 47 patients were imaged and a biopsy overview image was provided within a median acquisition time of 6 minutes after excision. The assessment by pathologists and an artificial intelligence algorithm showed that image quality was sufficient for a malignancy or nonmalignancy diagnosis in 97% of the biopsies, and 87% of the HHG images were correctly scored by the pathologists. HHG is therefore an excellent candidate to provide a rapid pathology outcome on biopsy samples, enabling immediate diagnosis and (local) treatment.

Development and Usability of an Endoscopist Report Card Assessing ERCP Quality

Audit and feedback (A&F) for endoscopic retrograde cholangiopancreatography (ERCP) is relatively understudied despite the demonstrated effectiveness of A&F for endoscopic procedures such as colonoscopy. Endoscopist 'report cards' are one A&F tool. We aimed to develop an ERCP report card and assess its appropriateness, acceptability and feasibility through usability testing. A prototype report card was designed using a combination of published quality indicators and established predictors of adverse events (AE). Exploratory analyses from a prospective multi-center registry were performed to further identify novel and/or understudied parameters for possible inclusion. Semi-structured interviews with ERCP endoscopists were conducted and framework analysis performed. Validated post-interview usability instruments were administered. Feedback was incorporated to create a final report card. The report card included domains of technical parameters, AE rates/prevention, and patient-reported experience measures (PREMs). Qualitative feedback was positive, with respondents agreeing with inclusion of relevant content in most domains. Post-interview instruments revealed adequate appropriateness and acceptability. PREMs were felt by respondents to be poorly actionable and were replaced with appropriateness of indication and fluoroscopy usage parameters in the final report card. Concerns were raised regarding the feasibility of implementation due to reliance on difficult-to-obtain granular intraprocedural data. We designed and tested an ERCP report card that has potential to be an effective A&F intervention for endoscopists in clinical practice. Though feasibility of data capture and implementation are currently limitations, advances in video recording and artificial intelligence technologies could accelerate widespread adoption of such a tool.

Safety of endoscopist-directed nurse-administered sedation in an Italian referral hospital: An audit of 2 years and 19,407 procedures

Background and study aimsBalanced propofol sedation (BPS) administered by adequately trained non-anaesthesiologist personnel has gained popularity in GI endoscopy because of its shorter procedure and recovery time, high patient satisfaction, and low rate of adverse events (AEs), despite being considered controversial. We report data from an audit of endoscopist-directed (ED) nurse-administered sedation in an Italian referral hospital. Patients and methodsConsecutive endoscopic procedures performed between 2020 and 2022 were considered. Under the guidance of the endoscopist, the nurse administered midazolam/fentanyl, followed by a progressive top-up dosage of a 10–20 mg bolus of propofol to achieve moderate to deep sedation. The endoscopists and nurses were all certified in our hospital with a continuous and scheduled training from 2006. ResultsDuring the study period, a total of 19,407 examinations (7,803 EGDS, 10,439 colonoscopies, 77 PEG, 697 EUS, and 365 ERCP) and 14,415 patients were included. Of these, 29.4 % of patients were classified as ASA I, 66.5 % as ASA II, and 5.1 % as ASA III. Hypotension was recorded in 1,293 (6 %) examinations and bradycardia in 176 (0.9 %) patients. Eleven patients (0.06 %) had minor respiratory adverse events. Two patients (0.01 %) had major AEs requiring orotracheal intubation. ConclusionsED-BPS is safe in low-risk patients. Major AEs occurred in 0.01 % of procedures.

Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis.

Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions. This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023. Department of Otolaryngology-Head & Neck Surgery, University of Arizona College of Medicine-Tucson. Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser-safe endotracheal tube in place through the stoma. Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success. A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.

Effect of simethicone on the bactericidal efficacy of a high-level disinfectant.

Introduction. Simethicone is an over-the-counter product that is frequently used by clinicians during endoscopic procedures to reduce foaming and improve visualization. Published studies have found simethicone residue on endoscopes after cleaning and disinfecting the devices as per the manufacturer's instructions. Some literature suggests that simethicone residue may reduce disinfection efficacy and increase the risk of patient infections.Gap Statement. However, there appears to be a lack of direct evidence in the literature to either disprove this or correlate simethicone presence with an increased microbial risk.Aim: Research was conducted to evaluate the in vitro impact of simethicone on disinfection efficacy.Methodology. Bacteria were grown in a microtitre plate assay in the presence of a range of simethicone concentrations and then treated with a disinfectant. Bacterial growth was assessed by spotting each microtitre well onto an agar plate.Results. The results demonstrated that, under the conditions tested, simethicone did not reduce the efficacy of Cidex ortho-phthalaldehyde disinfectant, which demonstrated at least a 6-log unit reduction in bacterial viability. Additional experiments showed that direct exposure to 66 mg ml-1 of simethicone reduced bacterial viability.Conclusion. These results indicate that simethicone may not reduce the bactericidal efficacy of disinfectant during reprocessing, under certain conditions.

Real-world evidence comparing early and late pancreatic stent placement to prevent post-ERCP pancreatitis

Abstract Background and study aims Pancreatic stenting effectively lowers the occurrence of post-ERCP pancreatitis (PEP) and reduces its severity. However, limited research has been conducted to determine the optimal timing for pancreatic stent placement. Our objective was to evaluate whether early pancreatic stent placement (EPSP) is more effective than late pancreatic stent placement (LPSP) in preventing PEP among patients with naive papilla. Patients and methods We conducted a retrospective cohort study that analyzed 590 patients with difficult biliary cannulation using the pancreatic guidewire technique, who were divided into EPSP and LPSP groups. In the EPSP group, a pancreatic stent was placed immediately before/after endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (EST). Conversely, in the LPSP group, a pancreatic stent was placed after partial/all completion of major endoscopic procedures. Results From November 2017 to May 2023, 385 patients were in the EPSP group and 205 in the LPSP group. EPSP was associated with a decreased PEP occurrence compared with LPSP (2.9% vs. 7.3%; P = 0.012). Similarly, hyperamylasemia was lower in the EPSP group (19.7% vs. 27.8%; P = 0.026). Furthermore, sensitivity analysis using multivariable analysis and propensity score–matched (PSM) analysis also validated these findings. Conclusions Early pancreatic stent placement reduced the incidence of PEP and hyperamylasemia compared with late pancreatic stent placement. Our findings favor pancreatic stenting immediately before/after ERC or EST.