Abstract
This study aimed to investigate the association between post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and early pancreatic stent dislodgement. A retrospective analysis was conducted on patients who underwent ERCP with prophylactic pancreatic stent placement at 3 academic institutions between January 2010 and December 2022. We evaluated the association between early stent dislodgement (≤24 hours) and PEP as well as the risk factors for early stent dislodgement. A total of 750 patients were analyzed in this study; 75 and 675 patients belonged to the early and non-early dislodgement groups, respectively. Early dislodgement significantly increased the risk of PEP (20.0% vs 7.3%, P < .001) and post-ERCP hyperamylasemia (40.0% vs 13.9%, P < .001). Early dislodgement was identified as an independent risk factor for PEP (OR, 2.960; 95% CI, 1.552-5.648; P = .001). Univariate and multivariate logistic regression analyses of factors related to early stent dislodgement demonstrated that suspected bile duct stone as an indication for ERCP (OR, 2.172; 95% CI, 1.232-3.828; P = .007), absence of periampullary diverticulum (OR, 2.206; 95% CI, 1.143-4.259; P = .018), and absence of an internal flange of the pancreatic stent (OR, 3.109; 95% CI, 1.689-5.723; P < .001) were significantly associated with early stent dislodgment. After propensity score matching adjusted for known risk factors for PEP and early stent dislodgement, early stent dislodgement was a significant risk factor for PEP (OR, 3.571; 95% CI, 1.589-8.028; P = .002), and stents without an internal flange (OR, 4.463; 95% CI, 2.214-9.380; P < .001) and age < 60 years (OR, 2.134; 95% CI, 1.152-3.955; P = .016) were significant risk factors for early dislodgement. In conclusion, early dislodgement of a prophylactic pancreatic stent increases the risk of PEP, and is associated with pancreatic stents without an internal flange.