Technical Factors Associated With the Benefit of Prophylactic Pancreatic Stent Placement During High-Risk Endoscopic Retrograde Cholangiopancreatography: A Secondary Analysis of the SVI Trial Data Set.

Gregory A Coté, Richard S Kwon, Jingwen Zhang, Jose Serrano, Amitabh Chak, Steven A Edmundowicz, Georgios I Papachristou, James M Scheiman, Shyam Varadarajulu, Field F Willingham, Nauzer Forbes, Rebecca L Spitzer, Cathie Spino, Lydia D Foster, Adam Slivka, Steven A Keilin, Rajesh Keswani, Joanna Law, Bret Petersen, Collins Ordiah, B Joseph Elmunzer, Valerie Durkalski-Mauldin, Zachary L Smith, Vladimir Kushnir, James Buxbaum, Mouen Khashab, Patrick Yachimski, Amit Rastogi, Daniel Mullady, John R Saltzman, Ji Young Bang, Yen-I Chen, Timothy B Gardner, Andrew Ross, Andrew Y Wang, Alan Barkun, Sachin Wani, Raj Shah, Vikesh K Singh

Journal: The American journal of gastroenterology 2025;120(4):811-815

PMID: 39207308

Full Text on Ovid Technologies, Inc. View on PubMed

Abstract

INTRODUCTION

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 patients who underwent successful stent placement, we studied the impact of (i) whether pancreatic wire access was achieved for the sole purpose of PSP or naturally during the conduct of the case, (ii) the amount of effort expended on PSP, (iii) stent length, (iv) stent diameter, and (v) 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; odds ratio [OR] 0.82, 95% confidence interval [CI] 0.37-1.84), whether substantial effort expended on stent placement (vs nonsubstantial effort; OR 1.58, 95% CI 0.73-3.45), stent length (>5 vs ≤5 cm; OR 1.01, 95% CI 0.63-1.61), stent diameter (≥5 vs <5 Fr; OR 1.13, 95% CI 0.65-1.96), or guidewire caliber (0.035 vs 0.025 in; 0.83, 95% CI 0.49-1.41).

DISCUSSION

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 PSP 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.

Address: Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.; Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, Oregon, USA.; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; Orlando Health Digestive Health Institute, Orlando Health, Orlando, Florida, USA.; Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.; Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.; Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.; Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.; Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California, USA.; Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USA.; Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.; Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Division of Gastroenterology, McGill University, Montreal, Quebec, Canada.; Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.; Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Public Health, University of Michigan, Ann Arbor, Michigan, USA.; Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.

DOI: 10.14309/ajg.0000000000003052

Link outs

Free resources

Medical:

https://medlineplus.gov/pancreatitis.html

Miscellaneous:

https://assays.cancer.gov/CPTAC-387

Subscription / membership required

Full Text Sources:

MeSH Terms: Aged, Female, Humans, Male, Middle Aged, Cholangiopancreatography, Endoscopic Retrograde, Logistic Models, Pancreatic Ducts, Pancreatitis, Postoperative Complications, Risk Factors, Stents