Pancreatic stent prophylaxis of post endoscopic retrograde cholangiopancreatography pancreatitis: Spontaneous migration rates and clinical outcomes

P. Chahal, T. H. Baron, Bret Thomas Petersen, Mark Topazian, C. J. Gostout, M. J. Levy

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aim. Pancreatic duct (PD) stents diminish the risk of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; 3 Fr stents are reported to spontaneously migrate at a significantly higher rate than 5 Fr stents in a cohort of mostly sphincter of Oddi (SOD) patients. We sought to assess spontaneous migration rates of 5 Fr and 7 Fr stents and effectiveness in preventing PEP in a diverse group of high risk patients. Methods. A total of 4 332 ERCP exams performed between January 2002 and August 2005 were reviewed to identify patients undergoing PD stent placement. Follow-up was obtained from electronic medical records and contact with referring MDs. Plain abdominal radiographs were used to document stent passage. Results. PD stents for PEP prophylaxis were placed in 246 exams (232 patients) undergoing: PD (major or minor) sphincterotomy (84), ampullectomy (50), SOD (46), bile duct precut (35), papillary stenosis balloon dilation (9) and difficult cannulation (8). Stents placed: 218 5-Fr (140 were 3 cm long and 78 ≥ 5 cm long) and 28 7-Fr (12 were 3 cm long, 16≥ 5cm long). Follow-up was available in 197 (171 5-Fr, 26 7-Fr) of 246 placements (80%). Twenty of 171 5-Fr stents were electively removed via EGD within≤ 24 h per endoscopist preference and were not included in analysis; 128 of the remaining 151 5-Fr stents (85%) spontaneously migrated by (or within) median of 8 days and 23 failed to pass and required EGD removal. Of 26 7-Fr stents one was electively removed ≤ 24 h later; of the remaining 25, 15 (60%) spontaneously migrated by median of 16 days, 10 required EGD removal The spontaneous migration rate of 5 Fr stents was: 1) significantly higher than 7 Fr stents; 2) significantly higher than the previously reported 67% passage rate of 5 Fr stents; and 3) similar to the previously reported 86% passage rate of 3 Fr stents. PEP occurred in 15% (n=36: 24 mild, 11 moderate, 1 severe). Conclusion. The spontaneous dislodgement rate of 5 Fr stents in patients where the indication is primarily non-SOD is approximately 85% - significantly higher than previously reported and similar to the reported rate of spontaneous dislodgement of 3 Fr stents in SOD patients; 5 Fr stents migrate spontaneously earlier and more frequently than 7 Fr stents.

Original languageEnglish (US)
Pages (from-to)225-230
Number of pages6
JournalMinerva Gastroenterologica e Dietologica
Volume53
Issue number3
StatePublished - Sep 2007

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Stents
Pancreatic Ducts
Sphincter of Oddi
Electronic Health Records

Keywords

  • Cholangiopancreatography, endoscopic retrograde
  • Pancreatitis
  • Postoperative complications
  • Stents

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{ddeb9cb9f1154d03add525024cd38423,
title = "Pancreatic stent prophylaxis of post endoscopic retrograde cholangiopancreatography pancreatitis: Spontaneous migration rates and clinical outcomes",
abstract = "Aim. Pancreatic duct (PD) stents diminish the risk of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; 3 Fr stents are reported to spontaneously migrate at a significantly higher rate than 5 Fr stents in a cohort of mostly sphincter of Oddi (SOD) patients. We sought to assess spontaneous migration rates of 5 Fr and 7 Fr stents and effectiveness in preventing PEP in a diverse group of high risk patients. Methods. A total of 4 332 ERCP exams performed between January 2002 and August 2005 were reviewed to identify patients undergoing PD stent placement. Follow-up was obtained from electronic medical records and contact with referring MDs. Plain abdominal radiographs were used to document stent passage. Results. PD stents for PEP prophylaxis were placed in 246 exams (232 patients) undergoing: PD (major or minor) sphincterotomy (84), ampullectomy (50), SOD (46), bile duct precut (35), papillary stenosis balloon dilation (9) and difficult cannulation (8). Stents placed: 218 5-Fr (140 were 3 cm long and 78 ≥ 5 cm long) and 28 7-Fr (12 were 3 cm long, 16≥ 5cm long). Follow-up was available in 197 (171 5-Fr, 26 7-Fr) of 246 placements (80{\%}). Twenty of 171 5-Fr stents were electively removed via EGD within≤ 24 h per endoscopist preference and were not included in analysis; 128 of the remaining 151 5-Fr stents (85{\%}) spontaneously migrated by (or within) median of 8 days and 23 failed to pass and required EGD removal. Of 26 7-Fr stents one was electively removed ≤ 24 h later; of the remaining 25, 15 (60{\%}) spontaneously migrated by median of 16 days, 10 required EGD removal The spontaneous migration rate of 5 Fr stents was: 1) significantly higher than 7 Fr stents; 2) significantly higher than the previously reported 67{\%} passage rate of 5 Fr stents; and 3) similar to the previously reported 86{\%} passage rate of 3 Fr stents. PEP occurred in 15{\%} (n=36: 24 mild, 11 moderate, 1 severe). Conclusion. The spontaneous dislodgement rate of 5 Fr stents in patients where the indication is primarily non-SOD is approximately 85{\%} - significantly higher than previously reported and similar to the reported rate of spontaneous dislodgement of 3 Fr stents in SOD patients; 5 Fr stents migrate spontaneously earlier and more frequently than 7 Fr stents.",
keywords = "Cholangiopancreatography, endoscopic retrograde, Pancreatitis, Postoperative complications, Stents",
author = "P. Chahal and Baron, {T. H.} and Petersen, {Bret Thomas} and Mark Topazian and Gostout, {C. J.} and Levy, {M. J.}",
year = "2007",
month = "9",
language = "English (US)",
volume = "53",
pages = "225--230",
journal = "Minerva Gastroenterologica",
issn = "0026-4776",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "3",

}

TY - JOUR

T1 - Pancreatic stent prophylaxis of post endoscopic retrograde cholangiopancreatography pancreatitis

T2 - Spontaneous migration rates and clinical outcomes

AU - Chahal, P.

AU - Baron, T. H.

AU - Petersen, Bret Thomas

AU - Topazian, Mark

AU - Gostout, C. J.

AU - Levy, M. J.

PY - 2007/9

Y1 - 2007/9

N2 - Aim. Pancreatic duct (PD) stents diminish the risk of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; 3 Fr stents are reported to spontaneously migrate at a significantly higher rate than 5 Fr stents in a cohort of mostly sphincter of Oddi (SOD) patients. We sought to assess spontaneous migration rates of 5 Fr and 7 Fr stents and effectiveness in preventing PEP in a diverse group of high risk patients. Methods. A total of 4 332 ERCP exams performed between January 2002 and August 2005 were reviewed to identify patients undergoing PD stent placement. Follow-up was obtained from electronic medical records and contact with referring MDs. Plain abdominal radiographs were used to document stent passage. Results. PD stents for PEP prophylaxis were placed in 246 exams (232 patients) undergoing: PD (major or minor) sphincterotomy (84), ampullectomy (50), SOD (46), bile duct precut (35), papillary stenosis balloon dilation (9) and difficult cannulation (8). Stents placed: 218 5-Fr (140 were 3 cm long and 78 ≥ 5 cm long) and 28 7-Fr (12 were 3 cm long, 16≥ 5cm long). Follow-up was available in 197 (171 5-Fr, 26 7-Fr) of 246 placements (80%). Twenty of 171 5-Fr stents were electively removed via EGD within≤ 24 h per endoscopist preference and were not included in analysis; 128 of the remaining 151 5-Fr stents (85%) spontaneously migrated by (or within) median of 8 days and 23 failed to pass and required EGD removal. Of 26 7-Fr stents one was electively removed ≤ 24 h later; of the remaining 25, 15 (60%) spontaneously migrated by median of 16 days, 10 required EGD removal The spontaneous migration rate of 5 Fr stents was: 1) significantly higher than 7 Fr stents; 2) significantly higher than the previously reported 67% passage rate of 5 Fr stents; and 3) similar to the previously reported 86% passage rate of 3 Fr stents. PEP occurred in 15% (n=36: 24 mild, 11 moderate, 1 severe). Conclusion. The spontaneous dislodgement rate of 5 Fr stents in patients where the indication is primarily non-SOD is approximately 85% - significantly higher than previously reported and similar to the reported rate of spontaneous dislodgement of 3 Fr stents in SOD patients; 5 Fr stents migrate spontaneously earlier and more frequently than 7 Fr stents.

AB - Aim. Pancreatic duct (PD) stents diminish the risk of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; 3 Fr stents are reported to spontaneously migrate at a significantly higher rate than 5 Fr stents in a cohort of mostly sphincter of Oddi (SOD) patients. We sought to assess spontaneous migration rates of 5 Fr and 7 Fr stents and effectiveness in preventing PEP in a diverse group of high risk patients. Methods. A total of 4 332 ERCP exams performed between January 2002 and August 2005 were reviewed to identify patients undergoing PD stent placement. Follow-up was obtained from electronic medical records and contact with referring MDs. Plain abdominal radiographs were used to document stent passage. Results. PD stents for PEP prophylaxis were placed in 246 exams (232 patients) undergoing: PD (major or minor) sphincterotomy (84), ampullectomy (50), SOD (46), bile duct precut (35), papillary stenosis balloon dilation (9) and difficult cannulation (8). Stents placed: 218 5-Fr (140 were 3 cm long and 78 ≥ 5 cm long) and 28 7-Fr (12 were 3 cm long, 16≥ 5cm long). Follow-up was available in 197 (171 5-Fr, 26 7-Fr) of 246 placements (80%). Twenty of 171 5-Fr stents were electively removed via EGD within≤ 24 h per endoscopist preference and were not included in analysis; 128 of the remaining 151 5-Fr stents (85%) spontaneously migrated by (or within) median of 8 days and 23 failed to pass and required EGD removal. Of 26 7-Fr stents one was electively removed ≤ 24 h later; of the remaining 25, 15 (60%) spontaneously migrated by median of 16 days, 10 required EGD removal The spontaneous migration rate of 5 Fr stents was: 1) significantly higher than 7 Fr stents; 2) significantly higher than the previously reported 67% passage rate of 5 Fr stents; and 3) similar to the previously reported 86% passage rate of 3 Fr stents. PEP occurred in 15% (n=36: 24 mild, 11 moderate, 1 severe). Conclusion. The spontaneous dislodgement rate of 5 Fr stents in patients where the indication is primarily non-SOD is approximately 85% - significantly higher than previously reported and similar to the reported rate of spontaneous dislodgement of 3 Fr stents in SOD patients; 5 Fr stents migrate spontaneously earlier and more frequently than 7 Fr stents.

KW - Cholangiopancreatography, endoscopic retrograde

KW - Pancreatitis

KW - Postoperative complications

KW - Stents

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M3 - Article

C2 - 17912184

AN - SCOPUS:36749073394

VL - 53

SP - 225

EP - 230

JO - Minerva Gastroenterologica

JF - Minerva Gastroenterologica

SN - 0026-4776

IS - 3

ER -