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Abstract

Abstract Background and study aims Prophylactic pancreatic duct stenting is an established strategy for reducing the risk of post-ERCP pancreatitis in high-risk patients, but the optimal stent length remains uncertain. We evaluated the association between 5 cm and longer (6–9-cm) 5 Fr prophylactic pancreatic stents and the incidence of post-ERCP pancreatitis. Patients and methods We conducted a retrospective cohort study at a tertiary referral center from 2015 to 2025, including 466 high-risk patients who underwent ERCP with prophylactic 5 Fr pancreatic stents of 5 cm or longer lengths. Patients were stratified according to stent length. Propensity score matching was performed to balance baseline characteristics and procedural factors between groups, and the incidence of PEP and available data on recorded stent-related complications were analyzed. Results PEP occurred in 15.7% of patients (73/466). In the propensity score–matched cohort, the incidence was significantly higher in patients with a 5-cm stent compared with those who received longer stents (22.2% vs 10.2%, P = 0.003). In multivariable conditional logistic regression, placement of a stent longer than 5 cm remained statistically associated with lower odds of PEP compared with placement of a 5-cm stent. No bleeding, perforation, or infection was documented in either group. Conclusion In this single-center retrospective cohort, longer prophylactic pancreatic stents (6–9 cm) were associated with a lower incidence of PEP than 5-cm stents after propensity score matching. Given the non-random selection of stent length and potential residual confounding, these findings should be interpreted as hypothesis-generating rather than as evidence of an independent or causal effect of stent length.