title: Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: OBJECTIVE
  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.affiliation: Digestive Health Associates of Texas, PA, Dallas, Texas, USA.
authors.forename: Prabhleen
authors.initials: P
authors.lastname: Chahal
authors.forename: Paul R
authors.initials: PR
authors.lastname: Tarnasky
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000517:prevention & control*; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome