Effectiveness of pancreatic stent placement in preventing post-ERCP pancreatitis: Experience of a Referral Center

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Aims Cannulation of the common bile duct (CBD) during ERCP can be challenging in many cases. This study aims to evaluate the effectiveness of using a pancreatic stent (PS) in these cases to prevent post-ERCP pancreatitis (PEP). It is the first organized study of this kind in Greece and Europe. Methods A retrospective record of patients undergoing their first ERCP between 1/1/2008 and 1/3/2024 at Venizeleion General Hospital (Crete, Greece), where a PS was placed due to unintended pancreatic duct cannulation on three or more attempts. Since 2015, all patients received a diclofenac suppository. Results Of the 6080 patients who underwent ERCP, 421 were included in this study (46.1% male). The mean age was 67.8 years (± 15.8). The primary indications for ERCP were choledocholithiasis (57.7%), biliary or pancreatic malignancies (26.6%), and benign CBD strictures (5.7%). Successful CBD cannulation was achieved in the first session for 364 patients (86.4%), with 11 (2.6%) undergoing transpancreatic sphincterotomy and 6 (1.4%) a needle-knife procedure. A second ERCP attempt was made in 33 patients (7.8%), achieving 100% success in CBD cannulation. Balloon dilation of the ampulla of Vater was performed in 39 cases (9.3%). PEP occurred in 21 patients (4.9%), of whom only 3 (0.7%) had severe cases. Incidence was higher in women compared to men (18/227 vs 3/194, p=0.001), while diclofenac administration did not significantly affect PEP incidence (12/202 vs 9/219, p=0.4). Overall, there were 3 deaths, one of which was related to PEP (0.2%). Conclusions The use of PS was associated with a low incidence of severe PEP, while diclofenac administration did not significantly affect PEP incidence. Additionally, PS placement in patients undergoing a second ERCP facilitated successful CBD cannulation in all cases. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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