Introduction The indications for placing pancreatic stents (PS) during endoscopic retrograde cholangio-pancreatography (ERCP) include pancreatic duct stones and strictures, prevention of post-ERCP pancreatitis and as an aid to biliary cannulation, where there is persistent preferential pancreatic cannulation. The flange at the proximal end of the stent used in our practice (Cook UK) is designed to prevent spontaneous migration. As a minimum, abdominal x-ray (AXR) should be performed at 4 weeks to confirm spontaneous stent passage. The aims of this study were to assess a) indications for PS b) compliance with AXR recommendation c) whether flange removal aids spontaneous stent passage.
Methods Retrospective review of ERCP reports and case notes in 1250 ERCPs performed at our institution between August 2011 and December 2013.
Results In 82 of 1250 ERCPs, PS were placed (6.5%). 31 male, 51 female, mean age 63 years (range 20–92).
The indication for PS placement in all 82 was to aid biliary cannulation, and in all 82, the PS was left in situ to reduce the pancreatitis risk. In 72/82, biliary cannulation was successful (pre-cut in 55).
42/82 had AXR, and in 36/42 the stent had passed.
21/82 had repeat ERCP and in 15/21 the stent had passed.
19/82 (23%) had no record of AXR or repeat ERCP.
Based on operator preference, the flange was removed in 38 and left in situ in 44. Of the 12 PS that failed to pass spontaneously the flange was removed in 4 and left in situ in 8.
Conclusion Pancreatic stents are a useful aid to biliary cannulation, and pass spontaneously in the majority of patients, although flange removal may facilitate this. Compliance with the minimum recommendation of post-ERCP AXR to confirm stent passage in only 77% is poor, and requires further investigation.
Disclosure of Interest None Declared.