P0014 - Delayed Evaluation and Clearance of Prophylactic Pancreatic Duct Stent Placed During ERCP

Joshua Martin, DO, Aisel Alikhanova, MD, Wichit Srikureja, MD, John J. Kim, MD, MS
Loma Linda University Health, Loma Linda, CA

Introduction: Prophylactic pancreatic duct (PD) stents are commonly placed during endoscopic retrograde cholangiopancreatography (ERCP) to reduce the risk of pancreatitis. Performing radiologic studies 10-14 days from ERCP to evaluate for spontaneous passage and subsequent endoscopic removal of retained PD stents are recommended to reduce the risk of stent-related PD injury. The aim of the study was to examine the adherence to timely evaluation and clearance of prophylactic PD stents placed during ERCP.

Methods: Consecutive patients who received ERCP with placement of a prophylactic PD stent (5/2014-10/2022) at a single center were identified from an endoscopic database. Patients with a PD stent placed for treatment of pancreatic disease or those with ≤4 weeks follow-up were excluded. Primary endpoint was the clearance of prophylactic PD stent ≤4 weeks from ERCP confirmed by passage (radiologic or endoscopic) or endoscopic removal. Multivariate analysis was performed to identify predictors associated with the study endpoint.

Results: Of 4,728 patients who underwent ERCP, 266 (5.6%) received a prophylactic PD stent (mean age 56.4±18.5 years, 170 female (64%)) placed by 13 different endoscopists and met the study criteria. Subsequently, 179 (67%) patients had evaluation of the prophylactic PD stent ≤2 weeks (mean of 4.2±4.1 days) from ERCP. Furthermore, 136 (51%) patients achieved clearance of the prophylactic PD stent ≤4 weeks (mean of 12.0±7.8 days) from ERCP (abdominal X-ray in 72 (53%), endoscopy in 25 (18%), ERCP in 24 (18%), and computerized tomography in 16 (11%)). On multivariate analysis, placement of a biliary stent reduced (AOR=0.37, 95%CI 0.21-0.65) the odds of clearing the prophylactic PD stent ≤4 weeks from ERCP after adjusting for endoscopist PD stent clearance rate (first (AOR=11.49, 95%CI 3.36-39.31), second (AOR=4.96, 95%CI 1.60-15.31), and third (AOR=3.53, 95%CI 1.14-10.96) compared to the fifth quintile). During a mean follow-up of 20.1±23.5 months, 47 (18%) patients had a documented retained PD stent >4 weeks from ERCP with a median dwelling time of 55 days (range, 29 to 929 days).

Discussion: Evaluation of prophylactic PD stents was performed ≤2 weeks in two-thirds and clearance ≤4 weeks was achieved in half of the patients following ERCP. In addition to a primarily endoscopist-driven factor, placing a concomitant biliary stent during ERCP was associated with delayed clearance of prophylactic PD stents.


Disclosures:


Joshua Martin, DO, Aisel Alikhanova, MD, Wichit Srikureja, MD, John J. Kim, MD, MS. P0014 - Delayed Evaluation and Clearance of Prophylactic Pancreatic Duct Stent Placed During ERCP, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.