INTRODUCTION Prophylactic pancreatic stent placement (PSP) is effective for preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high-risk cases, but the optimal technical approach to this intervention remains uncertain. METHODS In this secondary analysis of 787 clinical trial patients who underwent successful stent placement, we studied the impact of (i) whether pancreatic wire access was achieved for the sole purpose of PSP or naturally during the conduct of the case, (ii) the amount of effort expended on PSP, (iii) stent length, (iv) stent diameter, and (v) guidewire caliber. We used logistic regression models to examine the adjusted association between each technical factor and post-ERCP pancreatitis (PEP). RESULTS Ninety-one of the 787 patients experienced PEP. There was no clear association between PEP and whether pancreatic wire access was achieved for the sole purpose of PSP (vs occurring naturally; odds ratio [OR] 0.82, 95% confidence interval [CI] 0.37-1.84), whether substantial effort expended on stent placement (vs nonsubstantial effort; OR 1.58, 95% CI 0.73-3.45), stent length (>5 vs ≤5 cm; OR 1.01, 95% CI 0.63-1.61), stent diameter (≥5 vs <5 Fr; OR 1.13, 95% CI 0.65-1.96), or guidewire caliber (0.035 vs 0.025 in; 0.83, 95% CI 0.49-1.41). DISCUSSION The 5 modifiable technical factors studied in this secondary analysis of large-scale randomized trial data did not appear to have a strong impact on the benefit of prophylactic PSP in preventing PEP after high-risk ERCP. Within the limitations of post hoc subgroup analysis, these findings may have important implications in procedural decision making and suggest that the benefit of PSP is robust to variations in technical approach.

中文翻译：

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与高风险内镜逆行胰胆管造影期间预防性胰腺支架置入的益处相关的技术因素：SVI 试验数据集的二次分析。


引言 预防性胰腺支架置入（PSP）可有效预防高危病例内镜逆行胰胆管造影（ERCP）后的胰腺炎，但这种干预的最佳技术方法仍不确定。方法 在对 787 名成功接受支架置入的临床试验患者进行的二次分析中，我们研究了以下因素的影响：(i) 胰腺导丝通路是仅出于 PSP 目的还是在病例进行过程中自然实现，(ii) 胰丝通路的影响PSP 上花费的精力、(iii) 支架长度、(iv) 支架直径和 (v) 导丝直径。我们使用逻辑回归模型来检查每个技术因素与 ERCP 术后胰腺炎 (PEP) 之间的调整关联。结果 787 名患者中有 91 名经历了 PEP。 PEP 与是否仅出于 PSP 目的而实现胰腺导丝通路（相对于自然发生；比值比 [OR] 0.82，95% 置信区间 [CI] 0.37-1.84）、是否在支架上花费了大量精力之间没有明确的关联放置（与非实质性努力相比；OR 1.58，95% CI 0.73-3.45）、支架长度（>5 vs ≤5 cm；OR 1.01，95% CI 0.63-1.61）、支架直径（≥5 vs <5 Fr；OR 1.13 ，95% CI 0.65-1.96），或导丝口径（0.035 vs 0.025 英寸；0.83，95% CI 0.49-1.41）。讨论 在大规模随机试验数据的二次分析中研究的 5 个可修改的技术因素似乎并未对预防性 PSP 在预防高风险 ERCP 后 PEP 方面的益处产生重大影响。在事后亚组分析的限制内，这些发现可能对程序决策产生重要影响，并表明 PSP 的好处对于技术方法的变化是稳健的。