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

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 In all, 322 valid responses were collected (Europe = 285; non-EU = 32; not disclosed = 5). Centers 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 nonremoval were reported by 22.7% of the centers-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 centers apply heterogenous follow-up removal practices despite presence of guidelines.