Photo Credit: VectorMine

The following is a summary of “Risk of post-ERCP pancreatitis due to placement of biliary self-expandable metal stents (SEMS): a single-center retrospective study,” published in the March 2025 issue of Gastrointestinal Endoscopy by Radetic et al. 

Post-ERCP pancreatitis PEP is recognized as the most frequent complication associated with ERCP, often contributing to increased morbidity and healthcare utilization. While self-expandable metal stents (SEMS) are commonly deployed during ERCP for both benign and malignant biliary obstructions, their potential role in influencing the risk of PEP remains inadequately defined. This retrospective study aimed to evaluate whether SEMS placement is independently associated with an increased incidence of PEP. Researchers analyzed clinical data from 1,718 consecutive patients who underwent ERCP at the institution between 2016 and 2021. 

Patients were categorized into two cohorts: those who received SEMS placement (n=358; 21%) and those who did not. The primary outcome was the occurrence of PEP, and rates were compared between groups using univariate and multivariable analyses. Relevant confounders—such as procedure indication, use of rectal indomethacin, presence of a native papilla, and pancreatic duct manipulation or stenting—were adjusted for using a multivariable logistic regression model to isolate the effect of SEMS on PEP risk. The incidence of PEP was significantly higher in the SEMS group compared to the non-SEMS group (10.6% vs. 5.7%; p=0.0008). Furthermore, when compared specifically to patients who received plastic stents (n=494), the SEMS group also demonstrated a significantly greater risk of PEP (10.6% vs. 6.3%; p=0.0299). 

Importantly, multivariable logistic regression confirmed that SEMS placement was an independent predictor of PEP, with an adjusted (OR) of 2.30 (95% [CI], 1.48–3.56; p=0.0002). These findings suggest that the use of SEMS during ERCP confers a more than twofold increase in the risk of post-procedural pancreatitis, even after accounting for other known risk factors. The mechanisms underlying this association may include increased mechanical or thermal trauma during stent deployment, greater procedural complexity, or inadvertent pancreatic duct compression. Regardless of etiology, the results of this study highlight the need for heightened clinical vigilance when considering SEMS placement, particularly in patients with additional PEP risk factors. Consideration should be given to more selective use of SEMS or implementing enhanced prophylactic strategies, such as routine use of rectal NSAIDs or pancreatic duct stenting, in patients deemed at elevated risk. 

In conclusion, their single-center retrospective analysis identifies SEMS placement as a significant and independent risk factor for PEP, emphasizing the importance of individualized risk assessment in the decision-making process surrounding stent selection during ERCP procedures.

Source: giejournal.org/article/S0016-5107(25)01382-3/abstract