A survey of physician practices on prophylactic pancreatic stents

Background: Several prospective studies confirm that prophylactic stent placement in the pancreatic duct (PD) during high-risk FRCP procedures decreases the risk of post-FRCP 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 sphincterotormc 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 sphincterotomv (71%), prior post-FRCP 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 stems were left in place, and the retrieval method. Conclusions: Expert biliary endoscopists agree that prophylactic PD stenting is indicated during FRCP in high-risk patients. Wide variation exists in patient selection and stent placement technique.