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Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis.
Clin Gastroenterol Hepatol 2009; 7(8):834-9CG

Abstract

BACKGROUND & AIMS

Prophylactic placement of pancreatic duct (PD) stents reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in high-risk patients. Some endoscopists prefer longer length, unflanged 3Fr PD stents because they are supposedly more effective and have a higher rate of spontaneous dislodgement; we compared outcomes of patients with these 2 types of stents.

METHODS

Patients at high risk for PEP were randomly assigned to groups given either a straight, 5Fr, 3 cm long, unflanged PD stent (n = 116) or a 3Fr, 8 cm or longer, unflanged PD stent (n = 133). Abdominal radiographs were obtained at 24 hours, 7 days, and 14 days following stent placement to assess spontaneous stent dislodgement. PEP was defined according to consensus criteria.

RESULTS

After 14 days, the spontaneous stent dislodgement rates were 98% for 5Fr stents and 88% for 3Fr stents (P = .0001). PEP occurred in 12% of patients. The incidence of PEP was higher in the 3Fr group (14%) than the 5Fr group (9%), although this difference was not statistically significant (P = .3). Placement failure did not occur in any patients in the 5Fr stent group, but did occur in 11 of the 133 patients in the 3Fr stent group (P = .0003).

CONCLUSIONS

Among patients at high-risk for PEP, the spontaneous dislodgement rate of unflanged, short-length, 5Fr PD stents is significantly higher than for unflanged, long-length, 3Fr stents. This decreases the need for endoscopic removal. A higher rate of PD stent placement failure and PEP was observed in patients with 3Fr stents. To view this article's video abstract, go to the AGA's YouTube Channel.

Authors+Show Affiliations

Digestive Health Associates of Texas, PA, Dallas, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19447196

Citation

Chahal, Prabhleen, et al. "Short 5Fr Vs Long 3Fr Pancreatic Stents in Patients at Risk for Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 7, no. 8, 2009, pp. 834-9.
Chahal P, Tarnasky PR, Petersen BT, et al. Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol. 2009;7(8):834-9.
Chahal, P., Tarnasky, P. R., Petersen, B. T., Topazian, M. D., Levy, M. J., Gostout, C. J., & Baron, T. H. (2009). Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 7(8), pp. 834-9. doi:10.1016/j.cgh.2009.05.002.
Chahal P, et al. Short 5Fr Vs Long 3Fr Pancreatic Stents in Patients at Risk for Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. Clin Gastroenterol Hepatol. 2009;7(8):834-9. PubMed PMID: 19447196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. AU - Chahal,Prabhleen, AU - Tarnasky,Paul R, AU - Petersen,Bret T, AU - Topazian,Mark D, AU - Levy,Michael J, AU - Gostout,Christopher J, AU - Baron,Todd H, Y1 - 2009/05/15/ PY - 2008/10/08/received PY - 2009/04/24/revised PY - 2009/05/02/accepted PY - 2009/5/19/entrez PY - 2009/5/19/pubmed PY - 2009/9/29/medline SP - 834 EP - 9 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 7 IS - 8 N2 - BACKGROUND & AIMS: Prophylactic placement of pancreatic duct (PD) stents reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in high-risk patients. Some endoscopists prefer longer length, unflanged 3Fr PD stents because they are supposedly more effective and have a higher rate of spontaneous dislodgement; we compared outcomes of patients with these 2 types of stents. METHODS: Patients at high risk for PEP were randomly assigned to groups given either a straight, 5Fr, 3 cm long, unflanged PD stent (n = 116) or a 3Fr, 8 cm or longer, unflanged PD stent (n = 133). Abdominal radiographs were obtained at 24 hours, 7 days, and 14 days following stent placement to assess spontaneous stent dislodgement. PEP was defined according to consensus criteria. RESULTS: After 14 days, the spontaneous stent dislodgement rates were 98% for 5Fr stents and 88% for 3Fr stents (P = .0001). PEP occurred in 12% of patients. The incidence of PEP was higher in the 3Fr group (14%) than the 5Fr group (9%), although this difference was not statistically significant (P = .3). Placement failure did not occur in any patients in the 5Fr stent group, but did occur in 11 of the 133 patients in the 3Fr stent group (P = .0003). CONCLUSIONS: Among patients at high-risk for PEP, the spontaneous dislodgement rate of unflanged, short-length, 5Fr PD stents is significantly higher than for unflanged, long-length, 3Fr stents. This decreases the need for endoscopic removal. A higher rate of PD stent placement failure and PEP was observed in patients with 3Fr stents. To view this article's video abstract, go to the AGA's YouTube Channel. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/19447196/Short_5Fr_vs_long_3Fr_pancreatic_stents_in_patients_at_risk_for_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(09)00436-4 DB - PRIME DP - Unbound Medicine ER -