Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents.
BACKGROUND
There are conflicting data on the risk of post-ERCP pancreatitis (PEP) related to self-expandable metallic stents (SEMSs).


OBJECTIVE
To compare rates of PEP in patients who undergo biliary drainage with SEMSs or polyethylene stents (PSs).


METHODS
Retrospective, cohort study.


METHODS
Tertiary-care medical center.


METHODS
This study involved patients undergoing ERCP for malignant biliary obstruction between January 2005 and October 2008.


METHODS
First-time placement of a SEMS or PS for biliary decompression.


METHODS
Early post-ERCP complications, particularly PEP.


RESULTS
We identified 544 eligible patients, 248 SEMSs (102 covered), and 296 PSs. The etiology of malignant biliary obstruction was similar between groups, with 55% from pancreatic cancer. The frequency of PEP was significantly higher in the SEMS group (7.3%) versus the PS group (1.3%) (OR 5.7 [95% CI, 1.9-17.1]). On univariate analysis, patient age of <40 years, a history of PEP, and at least 1 pancreatic duct injection were also significant predictors of PEP, whereas female sex and having pancreatic cancer were not. When significant variables were added to a multiple-predictor regression model, the odds of PEP from SEMS placement increased to 6.8 (95% CI, 2.2, 21.4). However, the frequency of PEP was similar between covered (6.9%) and uncovered (7.5%) SEMSs (OR 0.9 [CI, 0.3-2.4]). Purported SEMS-specific risk factors, including the use of cSEMSs, overlapping SEMSs, or having a biliary sphincterotomy were not found to be significant contributors to the higher risk.


CONCLUSIONS
Retrospective design.


CONCLUSIONS
After we controlled for confounding variables, the frequency of PEP was significantly higher with placement of a SEMS compared with a PS. Rates of PEP were comparable with use of covered and uncovered SEMSs.
Coté
Gregory A
GA
Division of Gastroenterology, Washington University, St Louis School of Medicine, St Louis, Missouri, USA. gcote@iupui.edu
Kumar
Nitin
N
Ansstas
Michael
M
Edmundowicz
Steven A
SA
Jonnalagadda
Sreenivasa
S
Mullady
Daniel K
DK
Azar
Riad R
RR
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D008670:Metals; D010190:Pancreatic Neoplasms / Q000150:complications; D010195:Pancreatitis / Q000209:etiology*; D020959:Polyethylene; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*
D008670:Metals; D020959:Polyethylene