Background: Several 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.
Objective: To assess the current practice patterns of expert biliary endoscopists regarding prophylactic pancreatic duct stents.
Design: An anonymous survey was mailed to 54 expert biliary endoscopists, assessing volume of procedures, stent indications, method of placement, and follow-up.
Results: A 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.
Conclusions: Expert 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.