Indwelling double-pigtail plastic stents for treating disconnected pancreatic duct syndrome-associated peripancreatic fluid collections: long-term safety and efficacy

Abstract

Background and study aims: Long-term transmural double-pigtail stent (DPS) placement is recommended for patients with disconnected pancreatic duct syndrome (DPDS) and peripancreatic fluid collections (PFC). Long-term safety and efficacy of indwelling DPS were evaluated. Patients and methods: Medical files of patients treated with DPS for DPDS-associated PFC and a follow-up ≥48 months were reviewed. Early (<30 days) and late complications of DPS placement were evaluated and the primary endpoint –the incidence rate of late complications per 100 patients-years– was calculated. Short- and long term success rate of endoscopic treatment and PFC recurrence rate were among secondary endpoints. Results: From 2002 to 2014 we identified 116 patients [follow-up: 80.6 (34.4) months]. Among early complications (n=20), 6 occurred peri-interventionally. Late complications (n=17) were mainly pain due to DPS-induced ulcer or erosion (n=10) and 14 of these were treated conservatively or by stent removal. Two gastro-pancreatico-colo-cutaneous fistulas and one persisting bleed required surgical intervention. No DPS-related deaths were recorded. The incidence rate of late complications was 2.18 per 100 patient-years of follow-up; 95%CI [1.27, 3.49]. Short- and long-term success rate of endoscopic treatment was 97.4% [94.5, 100) and 94% [89.6, 98.3], respectively. The PFC recurrence rate was 28% [20.1, 35.9] and 92.3% of them occurred within the first two years. Stent migration, chronic pancreatitis and length of stent size (>6cm) were independently associated with higher rates of PFC recurrence. Conclusions: Long-term transmural drainage with DPS is a safe and effective treatment for DPDS-associated PFCs. However, about one fourth of PFC will recur.

Impact of transmural plastic stent on recurrence of pancreatic fluid collection after metal stent removal in disconnected pancreatic duct: a randomized controlled trial

“…In the overall study cohort, recurrent PFCs were noticed in 5.8 %, 16.3 %, and 19.2 % at 3 months, 6 months, and 12 months, respectively. Our results match those of earlier studies and suggest that recurrence of PFCs occurs in a considerable proportion of patients with DPD even after initial successful resolution 8 9 10 15 19 20 21 . There was no difference between the plastic stent vs. no-stent group in the incidences of recurrent PFCs at 3 months, 6 months, and 12 months.…”

“…A recent study from Belgium reported the outcomes of long-term indwelling plastic stents used for index drainage of PFCs. In this study, stent migration occurred in nearly three-quarters at a median follow-up of 19 months [20]. Therefore, it is likely that plastic stents eventually get expelled after resolution of the PFC.…”

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice

“…[18,19] In case pancreatic homogeneously fluid collections with pancreatic duct rupture, long-term indwelling atraumatic DPPSs are thought to represent a protection against recurrence. [20] Finally, retrospective evidence on the efficacy of EUS-guided drainage of postsurgical collections is increasingly showing high technical and clinical success, and this procedure has already become the standard of care for this indication in many high-volume cancer centers, allowing internal drainage of collections and early hospital discharge. [21]…”

To stent or not to stent: do we have an answer yet?

“…First, time is key to adequate judgement of PFC recurrence. Previous studies ( Table 1 s, see online-only Supplementary material) have evaluated PFC recurrence with a median follow-up of 11–34 months; 92 % of the recurrences occurred within the first 2 years 2 . Even the current study showed an increasing trend toward recurrence in the no-stent group between 3 months (5.8 %) and 12 months (25 %).…”