Frequency and Predictors of Delayed Clearance of Prophylactic Pancreatic Stents following ERCP.

Abstract

Background and aims: Timely evaluation and removal of prophylactic pancreatic stent (PS) placed during endoscopic retrograde cholangiopancreatography (ERCP) are recommended. The aim of the study was to examine the proportion of patients whose prophylactic PS passed or were removed within 4 weeks of ERCP.

Methods: Consecutive patients who received ERCP with prophylactic PS (5/2014- 11/2022) at a tertiary center were identified. Primary endpoint was clearance of PS ≤4 weeks from ERCP confirmed by radiologic studies or endoscopy. Multivariate analysis was used to identify endoscopist, patient, and procedure-related factors associated with the primary endpoint.

Results: Of 4,724 patients undergoing ERCP, 262 (5.5%) received a prophylactic PS (mean age 56.6±18.5 years, 168 (64%) female). After ERCP, PS was evaluated in ≤2 weeks in 177 (68%, 95%CI 62-73%) patients. Furthermore, PS was cleared at ≤4 weeks in 135 (52%, 95%CI 46-58%) patients by radiologic studies in 86 (33%) or endoscopic removal in 49 (19%). On multivariate analysis, biliary stent placement (AOR=0.5, 95%CI 0.3-0.8) reduced the odds of PS clearance after adjusting for endoscopist-specific clearance rate: top (AOR=11.1, 95%CI 4.0-30.5), second (AOR=5.4, 95%CI 2.5-11.9), and third (AOR=4.1, 95%CI 1.9-9.0) compared to the bottom quartile. During follow-up of 20.1±23.5 months, 47 (37%) of 127 patients with delayed PS clearance demonstrated a median stent dwelling time of 55 days (range, 29 to 929).

Conclusion: Prophylactic PS was cleared within 4 weeks in only half of the patients following ERCP. In addition to primarily endoscopist-driven factors, biliary stent placement was associated with delayed clearance of prophylactic PS.