A survey of physician practices on prophylactic pancreatic stents

BackgroundSeveral prospective studies confirm that prophylactic stent placement in the pancreatic duct (PD) during high-risk ERCP procedures decreases the risk of post-ERCP pancreatitis. Inconsistencies exist regarding the indications for prophylactic PD stent placement, the type of stent used, and stent follow-up.ObjectiveTo assess the current practice patterns of expert biliary endoscopists regarding prophylactic pancreatic duct stents.DesignAn anonymous survey was mailed to 54 expert biliary endoscopists, assessing volume of procedures, stent indications, method of placement, and follow-up.ResultsA total of 91% (49/54) of surveys were returned and analyzed. Prophylactic PD stents were used by 96% of respondents. Stent use was universal during ampullectomy and pancreatic sphincterotomy. Most also used stents for minor papillotomy (93%) and sphincter of Oddi dysfunction (SOD) confirmed by manometry (82%). Endoscopists disagreed on the following: pre-cut sphincterotomy (71%), prior post-ERCP pancreatitis (64%), suspected SOD (58-69%), and traumatic sphincterotomy (44%). Endoscopists used straight stents (33%), pigtail stents (30%), or a combination (33%). Internal flanges were always used by 14%, never used by 54%, and sometimes used by 32%. Stent size and length varied widely, as did the time stents were left in place, and the retrieval method.ConclusionsExpert biliary endoscopists agree that prophylactic PD stenting is indicated during ERCP in high-risk patients. Wide variation exists in patient selection and stent placement technique.