10 Fr S-Type Plastic Pancreatic Stents in Chronic Pancreatitis Are Effective for the Treatment of Pancreatic Duct Strictures and Pancreatic Stones

Abstract

Aim Endoscopic pancreatic stenting for refractory pancreatic duct strictures associated with impacted pancreatic stones in chronic pancreatitis cases has yielded conflicting results. We retrospectively evaluated the efficacy of endoscopic treatment in chronic pancreatitis patients with pancreatic duct strictures. Methods Pancreatic sphincterotomy, dilatation procedures, pancreatic brush cytology, and pancreatic juice cytology were routinely performed, and malignant diseases were excluded. After gradual dilatation, a 10 Fr plastic pancreatic stent was inserted. The stents were replaced every 3 months and removed after the strictures were dilated. Statistical analyses were performed to determine the risk of main pancreatic duct restenosis. Results Endoscopic pancreatic stents were successfully placed in 41 of a total of 59 patients (69.5%). The median duration of pancreatic stenting was 276 days. Pain relief was obtained in 37 of 41 patients (90.2%). Seventeen patients (41.5%) had recurrence of main pancreatic duct stricture, and restenting was performed in 16 patients (average placement period 260 days). During the follow-up period, pancreatic cancer developed in three patients (5.1%). Multivariate analysis revealed that the presence of remnant stones after stenting treatment was significantly associated with a higher rate of main pancreatic duct restenosis (p = 0.03). Conclusion The use of 10 Fr S-type plastic pancreatic stents with routine exchange was effective for both short-term and long-term outcomes in chronic pancreatitis patients with benign pancreatic duct strictures and impacted pancreatic stones.

The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis

“…Altogether 68 patients had endoscopic therapy: pancreatic sphincterotomy (100%), PD stenting (52%), and stone extraction (23.4%). Stents were exchanged every 2-4 months with a median stenting time of 16 months (range of [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In a surgery group, 61 patients underwent resections (80%) and 15 cases underwent draining procedure (20%).…”

“…Dominant PD strictures may be treated with PD dilatation and stenting. Often, 10 Fr stents are recommended and stenting time should be at least 1 year (10)(11)(12). Malignancy should be excluded with brush cytology and abdominal imaging.…”

“…Stricture recurrence was observed in 17 (41.5%) patients. risk factors for restenosis were remaining stones in PD after stent removal or stricture location in the body of pancreas (12). refractory CP pain after the removal of pancreatic stent is common.…”

Impact of physiologically shaped pancreatic stent for chronic pancreatitis

“…Deposition of a protein plug and an increase in the viscosity of pancreatic juice result in stent occlusion. Because of the high occlusion rate, pancreatic stents are recommended to be replaced approximately every 3 months 20 .…”

“…To overcome this, a physiologically shaped pancreatic stent was made, and available in our institution since July 2019. Although the feasibility of shape devised pancreatic stents has been reported 20 , 21 , the studies were single arm, and few comparative studies assessing stent shape have been performed.…”