Frequency and predictors of delayed clearance of prophylactic pancreatic stents after ERCP

Abstract

Background and Aims Timely evaluation and removal of prophylactic pancreatic stents (PSs) placed during ERCP are recommended. The aim of the study was to examine the proportion of patients whose prophylactic PSs passed or were removed within 4 weeks of ERCP. Methods Consecutive patients who received ERCP with prophylactic PS placement (May 2014 to October 2022) at a tertiary center were identified. The primary endpoint was clearance of the 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 4724 patients undergoing ERCP, 262 (5.5%) received a prophylactic PS (mean age, 56.6 ± 18.5 years; 168 [64%] women). After ERCP, PSs were evaluated in ≤2 weeks in 177 patients (68%; 95% CI, 62-73). Furthermore, PSs were cleared at ≤4 weeks in 135 patients (52%; 95% CI, 46-58) by radiologic studies in 86 (33%) or endoscopic removal in 49 (19%). On multivariate analysis, biliary stent placement (adjusted odds ratio [aOR], 0.5; 95% CI, 0.3-0.8) reduced the odds of timely PS clearance after adjusting for endoscopist-specific clearance rates: 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 with the bottom quartile. During follow-up of 20.1 ± 23.5 months, 47 of 127 patients (37%) with delayed PS clearance demonstrated a median stent dwelling time of 55 days (range, 29-929). Conclusions Prophylactic PSs were cleared within 4 weeks in only half of the patients after ERCP. In addition to primarily endoscopist-driven factors, biliary stent placement was associated with delayed clearance of prophylactic PSs.