Practices and Perspectives on Prophylactic Pancreatic Stent Removal Practice: The PIRATE Survey.

Abstract

Background and aim: Prophylactic pancreatic stent placement (PPSP) is recommended in high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis (PEP). Only a few societies, including the European Society of Gastrointestinal Endoscopy (ESGE), provide guidance on stent management, recommending assessment of spontaneous passage within 5–10 days and endoscopic removal if retained. However, evidence on real-life adherence to these recommendations remains limited. The primary aim was to assess clinical practices related to PPS removal, methods, timing and adherence to current guidelines. Methods: An online 13-item survey was distributed via professional networks and social media between November 2024 and February 2025 to assess current PPSP and removal practices. Results: 322 valid responses were collected (Europe = 285; non-EU = 32; not disclosed = 5). Centres were stratified by annual ERCP volume (procedures/years): <300 (28.3%), 300–500 (31.7%), and >500 (40.1%). Approximately 40 % of respondents did routinely place a PPS in high-risk situations. PPSP was most often inserted after >2 pancreatic duct cannulations (83.5%) or papillectomy (58.7%). Straight 5 Fr, 5 cm stents predominated (54% and 85.4%, respectively). Removal practices varied: 62.7% performed endoscopic retrieval, 47% within one week and 41.6% within four weeks; 55% had no fixed follow-up schedule. Complications of non-removal were reported by 22.7% of centres—mainly pancreatitis (63%)—yet 96% considered these rare. Overall, 31.7% followed ESGE or internal guidance, while 23.6% reported following no guidance. Conclusions: The PIRATE survey reveals that most centres apply heterogenous follow up removal practices despite presence of guidelines.