To evaluate the clinical effectiveness of prophylactic pancreatic duct stenting in reducing the incidence and severity of post-ERCP pancreatitis in patients undergoing high-risk endoscopic retrograde interventions.

From January 2020 to August 2023, a total of 1034 retrograde endoscopic interventions were performed at City Clinical Hospital No. 4 (Sochi). Prophylactic PD stenting was applied in 42 patients (4.1%). Plastic 5Fr stents (3–5 cm) were used. Main indications included: repeated guidewire passage into the pancreatic duct (>2 times) and contrast reflux into the duct. The majority of patients had obstructive jaundice caused primarily by choledocholithiasis (64.3%). All planned interventions were successfully completed.

Among the 42 stented patients, PEP developed in 6 (14.3%), including 4 mild (9.5%) and 2 severe cases (3.75%); asymptomatic hyperamylasemia occurred in 3 patients (7.1%) /Severe cases demonstrated transient marked hyperamylasemia (>1000 mg/L) and ultrasound-confirmed pancreatic changes; all responded to conservative therapy. One death occurred due to unrelated advanced rectal cancer, without signs of pancreatitis. Pain relief and decrease of amylase levels were observed within 24–48 hours in most cases.

1. PEP prevention remains essential due to high morbidity and frequent occurrence after technically challenging ERCPs.
2. Prophylactic PD stenting is effective in high-risk situations such as repeated pancreatic duct access or contrast reflux.
3. In our cohort, stenting contributed to limiting the severity of PEP, with rapid clinical recovery in most cases.
4. Combined with other preventive measures, prophylactic PD stenting remains the most reliable and evidence-based strategy for PEP prevention.