Post written by Bashar Qumseya, MD, MPH, FASGE, from the University of Florida, Gainesville, Florida, USA.

This study focuses on the risk of post-ERCP pancreatitis (PEP) in patients who receive self-expandable metal stents (SEMSs) compared with plastic biliary stents at the time of ERCP.

We observed several patients who underwent PEP with seemingly no other risk factors: no pancreatic duct cannulation on injection, cannulation not prolonged or difficult, etc. The only common risk among these patients was SEMSs were placed at the time of ERCP.

We performed a retrospective cohort study of more than 1700 patients who underwent ERCP at our institution. We found that the risk of PEP was higher in patients who had SEMS placement than those who did not. We controlled various confounders such as pancreatic duct manipulation, native papilla, use of a needle-knife, rectal indomethacin, procedure indication, and procedure duration. On multivariable logistic regression analysis, SEMS placement was found to be independently associated with an increased risk of post-ERCP (adjusted odds ratio, 2.30; 95% CI, 1.48-3.56; P = .0002).

Endoscopists should consider this when faced with a decision to place a biliary stent during ERCP and may want to avoid SEMS placement in patients with multiple underlying risk factors for PEP. 

Graphical abstract

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