Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-Fr pancreatic plastic stents placed with common-type guidewires: Results from a prospective multinational registry

the Pancreatic Stenting Registry Group

Research output: Contribution to journalArticle

Abstract

Background and Aim: Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods: High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results: One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty-one (76%) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions: Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

Original languageEnglish (US)
Pages (from-to)299-306
Number of pages8
JournalDigestive Endoscopy
Volume31
Issue number3
DOIs
StatePublished - May 1 2019

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Plastics
Stents
Registries
Peptamen
Pancreatic Ducts
Documentation

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

@article{24686910e51f45dda473212c946da68b,
title = "Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-Fr pancreatic plastic stents placed with common-type guidewires: Results from a prospective multinational registry",
abstract = "Background and Aim: Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods: High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results: One hundred six (106) patients received PPS for PEP prophylaxis [61 (58{\%}) primary, 45 (42{\%}) secondary prophylaxis]. Median age was 54 years. Eighty-one (76{\%}) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93{\%}) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100{\%} of cases. Two patients in the primary prophylaxis group (3{\%}, 95{\%} CI 0.4–11{\%}) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions: Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3{\%}, 95{\%} CI 0.4–11{\%}) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.",
author = "{the Pancreatic Stenting Registry Group} and Nadav Sahar and Andrew Ross and Sundeep Lakhtakia and Cot{\'e}, {Gregory A.} and Horst Neuhaus and Bruno, {Marco J.} and Oleh Haluszka and Richard Kozarek and Mohan Ramchandani and Torsten Beyna and Poley, {Jan W.} and Jennifer Maranki and Martin Freeman and Prashant Kedia and Paul Tarnasky",
year = "2019",
month = "5",
day = "1",
doi = "10.1111/den.13311",
language = "English (US)",
volume = "31",
pages = "299--306",
journal = "Digestive Endoscopy",
issn = "0915-5635",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-Fr pancreatic plastic stents placed with common-type guidewires

T2 - Results from a prospective multinational registry

AU - the Pancreatic Stenting Registry Group

AU - Sahar, Nadav

AU - Ross, Andrew

AU - Lakhtakia, Sundeep

AU - Coté, Gregory A.

AU - Neuhaus, Horst

AU - Bruno, Marco J.

AU - Haluszka, Oleh

AU - Kozarek, Richard

AU - Ramchandani, Mohan

AU - Beyna, Torsten

AU - Poley, Jan W.

AU - Maranki, Jennifer

AU - Freeman, Martin

AU - Kedia, Prashant

AU - Tarnasky, Paul

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background and Aim: Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods: High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results: One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty-one (76%) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions: Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

AB - Background and Aim: Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods: High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results: One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty-one (76%) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions: Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

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U2 - 10.1111/den.13311

DO - 10.1111/den.13311

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C2 - 30887733

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VL - 31

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EP - 306

JO - Digestive Endoscopy

JF - Digestive Endoscopy

SN - 0915-5635

IS - 3

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