Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis

Sofi, Aijaz; Khan, Muhammad Ali; Ahmad, Sumair; Khan, Zubair; Peerzada, Maajid Mumtaz; Jang, Sunguk; Vargo, John J.

doi:10.1016/j.pan.2021.03.017

Cited by 18 publications

(17 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A comparative study showed that in direct comparison to multiple plastic stents, the clinical outcome in terms of pain improvement was similar (WPR 88% vs. 89%). However, the rate of adverse events was significantly higher in the SEMS group compare to the PPS group (WPR 38.6% vs. 14.3%) (30).…”

Section: Pancreatic Stricturesmentioning

confidence: 77%

Stent placement in pancreatic disease, when, which and why? – a current perspective

Conrad¹,

Ellrichmann²

2023

Front. Gastroenterol.

View full text Add to dashboard Cite

IntroductionStenting of the pancreas is a challenging task for the interventional gastroenterologist. The indications for pancreatic stent implantation are either prophylactic or therapeutic. We give an overview of currently available literature and techniques for the respective indications of pancreatic stent placement.MethodsA structured literature research was conducted (Pubmed.gov) primarily using the following key words: interventional endoscopy, pancreatic stenting, post-ERCP pancreatitis, pancreatic Q8 fistulae, pancreas divisum.ResultsProphylactic stent implantation aims to prevent PEP by using thin (3-5 Fr) and short (3-5 cm) designated pancreatic stents at least in high-risk patients. Therapeutic stent placement is intended to restore the proper flow of pancreatic secretion with stenoses, leaks, fistulas or anatomical malformation of the pancreatic duct. Depending on the etiology, plastic stents or SEMSs are used. Another field of pancreatic stenting represents EUS-guided puncture with stent implantation as an alternative access to the main pancreatic duct when transpapillary access is impossible. In addition to the implantation of plastic stents, which achieve good results, LAMS implantation can be discussed as an alternative access route.DiscussionThe field of pancreatic stenting is complex and belongs in the hands of experienced endoscopists in specialized institutions. This can ensure that the patient receives the optimal treatment with the best possible outcome.

show abstract

Section: Pancreatic Stricturesmentioning

confidence: 77%

Stent placement in pancreatic disease, when, which and why? – a current perspective

Conrad¹,

Ellrichmann²

2023

Front. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…Our three patients were diagnosed with complete MPD disruption after the initial ERCP procedure and a 7-Fr plastic stent was placed but considered ineffective. It has been reported in the literature that FCSEMS placement can be used to treat pancreatic duct stenosis ( 12 ). For our three patients, we tried to replace the plastic stent with an FCSEMS with a diameter of 8 mm.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transpapillary drainage for walled-off pancreatic necrosis with complete main pancreatic duct disruption by metallic stent placement: A retrospective study

Meng¹,

Ding²,

Tian³

et al. 2022

Front. Med.

View full text Add to dashboard Cite

BackgroundWalled-off pancreatic necrosis (WOPN) is a serious complication of acute necrotizing pancreatitis (ANP) and may lead to disruption of the main pancreatic duct (MPD). Endoscopic passive transpapillary drainage (PTD) is an effective method for treating MPD disruptions. However, WOPN with complete MPD disruption is usually accompanied by disconnected pancreatic duct syndrome (DPDS), especially with infected necrosis. Endoscopic PTD with a fully covered self-expanding metallic stent (FCSEMS) and a plastic stent placement may have the potential for future application in treating complete MPD disruption in patients with WOPN.MethodsPatients with WOPN caused by ANP were classified according to the 2012 Atlanta classification and definition. In all patients, ERCP was performed 2 times. First, 3 patients were diagnosed with complete MPD disruption by ERCP. At the time of diagnosis, a plastic pancreatic stent (7Fr) was placed. Second, they underwent endoscopic PTD for WOPN with complete MPD disruption in which an FCSEMS and plastic stent placement were the only access routes to the necrotic cavity.ResultsThe etiology of pancreatitis in these patients was of biliary, lipogenic, and alcoholic origin. The WOPN lesion size ranged from 6.5 to 10.2 cm in this study, and the type of WOPN was mixed in two cases and central in one case. The type of MPD disruption was complete in all three patients. The locations of disruption included the pancreatic body and head. The time from occurrence to the first ERCP was 18, 23, and 26 days, respectively. The main symptoms were abdominal pain, abdominal distention, fever, gastrointestinal obstruction, and/or weight loss. The three patients with symptomatic WOPN and MPD disruption underwent endoscopic PTD with FCSEMS and plastic pancreatic stent placement. Technical and therapeutic successes were achieved in 3/3 of patients. The mean time of stenting was 28–93 days. The clinical symptoms connected with WOPN and collection disappeared postoperatively in all three patients. During the follow-up period of 4–18 months, no patient developed collection recurrence or other complications, such as gastrointestinal bleeding or reinfection. All patients recovered uneventfully.ConclusionIn patients with WOPN with complete MPD disruption, endoscopic PTD with FCSEMSs and plastic stent placement may be an effective and safe method of treatment.

show abstract

“…14,60 A meta-analysis of 13 studies has demonstrated that FCSEMSs appear to have no significant advantage over multiple plastic stents in the treatment of symptomatic refractory MPD strictures and are associated with an increased risk of adverse events. 61 The timing of removal of FCSEMSs is currently unclear. In a meta-analysis, although stent placement for >3 months did not achieve a significantly higher resolution rate than that for ≤3 months, it has a lower stricture recurrence rate.…”

Section: Cpmentioning

confidence: 99%

“…If symptomatic dominant strictures persist or relapse 1 year after single pancreatic stent placement, refractory MPD strictures may occur; then multiple side‐by‐side plastic stents and SEMSs can act as alternatives, with an efficacy of 84% and 93%, respectively 14,60 . A meta‐analysis of 13 studies has demonstrated that FCSEMSs appear to have no significant advantage over multiple plastic stents in the treatment of symptomatic refractory MPD strictures and are associated with an increased risk of adverse events 61 . The timing of removal of FCSEMSs is currently unclear.…”

Section: Efficacy Of Endoscopic Stent Placementmentioning

confidence: 99%

Pancreatic duct stents

Yi¹,

Li²,

Hu³

2022

J of Digest Diseases

View full text Add to dashboard Cite

Pancreatic duct stenting using endoscopy or surgery is widely used for the management of benign and malignant pancreatic diseases. Endoscopic pancreatic stents are mainly used to relieve pain caused by chronic pancreatitis and pancreas divisum, and to treat pancreatic duct disruption and stenotic pancreaticointestinal anastomosis after surgery. They are also used to prevent postendoscopic retrograde cholangiopancreatography pancreatitis and postoperative pancreatic fistula, treat pancreatic cancer, and locate radiolucent stones. Recent advances in endoscopic techniques, such as endoscopic ultrasonography and balloon enteroscopy, and newly designed stents have broadened the indications for pancreatic duct stenting. In this review we outlined the types, insertion procedures, efficacy, and complications of endoscopic pancreatic duct stent placement, and summarized the applications of pancreatic duct stents in surgery.

show abstract

Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis

Cited by 18 publications

References 20 publications

Stent placement in pancreatic disease, when, which and why? – a current perspective

Stent placement in pancreatic disease, when, which and why? – a current perspective

Endoscopic transpapillary drainage for walled-off pancreatic necrosis with complete main pancreatic duct disruption by metallic stent placement: A retrospective study

Pancreatic duct stents

Contact Info

Product

Resources

About