Pull the stent! Variability of prophylactic pancreatic stent placement and removal: The PIRATE Survey
Bildiriler > Tam Metin Bildiri
Yazarlar: M Zimmerli, E De Madaria, E Dieninyte, D S Paula, S Schlosser, A Wannhoff, Abdullah Murat BUYRUK, L Guilabert, L Kunovsky, A Mohamed, A Feiden, L Welsch, S Reichermeier, C B Conti, H Heinrich
Endoscopy, , , Uluslararası, Tam Metin Bildiri, Wos, cilt 57
Özet
Aims Prophylactic pancreatic stent placement (PPSP) is recommended in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis (PEP). However, only two guidelines, including the European Society of Gastrointestinal Endoscopy (ESGE), provide advice on how, when, and if PPS should be removed. The ESGE advises evaluating stent passage within 5–10 days and endoscopic removal, with stents remaining in place for a minimum of 12–24 hours. Literature indicates that 80–90% of PPS pass spontaneously, with few complications of non-removal reported. Documented complications of PPS removal, although rare, include perforation, bleeding, stent fracture, migration, and occlusion. This survey aimed at interrogating practice of PPSP and removal. Methods A 13-item online survey distributed via social media was conducted over two weeks, collecting 205 responses (Europe: 190; International: 15). Respondents were categorized by annual ERCP volume:<300 (31.2%), 300–500 (30.7%), and>500 (38%). Results 80% of respondents did not routinely place a PPS in high-risk patients per se or after unintentional pancreatic duct (PD) cannulation. PPS placement was considered most indicated after multiple PD cannulations (80%) or papillectomy (58%). Additional indications included precut sphincterotomy, accidental PD opacification, and therapeutic PD interventions. Straight stents were used by 75%, with mono pigtails utilized by 41.2%. The most utilized stents were 5 French (85%) and 5 cm in length (60.2%). Survey respondents reported removal times ranging from within one week (45.6%) to up to four weeks (44.8%), with 60% using gastroscopy after radiographic confirmation of lack of spontaneous passage. Only 13.6% employed ultrasound. Over half (56%) did not schedule fixed appointments for stent retrieval.22% of respondents reported complications of non-removal, including pancreatitis (67%), perforation (11.9%), PD aberrations (39%), and stent migration (4%). Despite these findings, 97.8% considered complications of PPS to be rare. 75% followed ESGE or internal guidelines and believed that PPS should be removed despite spontaneous passage occurring in 80–90% of cases. 25% of respondents did not refer to any guidelines. Conclusions This survey underscores the variability in PPSP and removal practices as well as limited guidance on removal timing and strategies. While with minimal complications, adherence to standardized practices could further improve patient outcomes and reduce complications. 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