Transcystic Stents: Zero Post-ERCP Pancreatitis Downstream
Post-ERCP pancreatitis is the complication endoscopists fear most, and difficult cannulation is its biggest driver. Marshall-Webb and colleagues show how surgeons can defuse both at the index operation: an antegrade stent placed through the cystic duct during cholecystectomy. Placement succeeded in 45 of 49 attempts (91.8%). Among patients whose stent remained in place at the subsequent ERCP, cannulation succeeded in 97.1% and post-ERCP pancreatitis did not occur versus 4.6% in 1,326 native-papilla controls. Median length of stay fell from 6.0 to 4.0 days (P=.014), with 40% of patients discharged before their ERCP. With a learning curve the authors estimate at 5-10 cases, transcystic antegrade stenting turns the hardest, riskiest part of a two-stage pathway into a routine exchange.
Citation
Marshall-Webb M, Smart G, Chao P, Hassen S, Fox A. Role of trans-cystic stenting in management of choledocholithiasis during cholecystectomy. ANZ J Surg. 2026;96(5):1234-1238. doi:10.1111/ans.70586
