A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures

Abstract

Background/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.Methods: This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.Results: Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.Conclusions: FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study

“…The reference population here consisted of 382 (44%) patients who completed the EORTC QLQ‐C30 questionnaire a median of two 1–39 years after their diagnosis. The two groups did not differ in age, sex, alcohol or by aetiology but the reference population had a shorter disease duration ( p < 0.001) and more smoking ( p = 0.029).…”

“…Symptomatic pancreatic strictures, duct stones and pancreatic leaks can be treated with endoscopic pancreatic duct stenting 31 . Pancreatic duct stenting can offer pain relief in duct strictures in up to 90% in the short term, but in the long‐term surgery may yield a better result 28,32,33 …”

“…31 Pancreatic duct stenting can offer pain relief in duct strictures in up to 90% in the short term, but in the longterm surgery may yield a better result. 28,32,33 Even though the EP patients used more opioids than the reference population, the number of patients with constant pain was the same as that in the reference population. In a recent study it was found that pain was independent on disease duration but did seem to decrease over time, probably due to medical treatment and interventions.…”

Pancreatic duct stents

“…1 The diameter and length of the currently available SEMSs vary from 6 to 15 mm and 4 to 12 cm, respectively (Table 2). 19,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] SEMSs can be classified as uncovered, partially covered, and fully covered SEMSs (FCSEMSs).…”

“…The diameter and length of the currently available SEMSs vary from 6 to 15 mm and 4 to 12 cm, respectively (Table 2). 19,28,31‐47 SEMSs can be classified as uncovered, partially covered, and fully covered SEMSs (FCSEMSs). The additional membrane of covered metal stents, which prevents tissue ingrowth, is made of silicone, polyurethane, or polytetrafluoroethylene 1,32 .…”