Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents.

Devière, Jacques; Cremer, Michel; Baize, Michel; Love, Jonathan; Sugai, Beatriz; Vandermeeren, Alain

doi:10.1136/gut.35.1.122

Cited by 161 publications

(95 citation statements)

References 14 publications

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“…[7][8][9][10][11] Uncovered metal stents have been placed in refractory BBS patients. [12][13][14] However, their long-term efficacy has been limited owing to their lack of long-term patency. 12,14 Their placement has been associated with epithelial hyperplasia and embedding the stent in the bile duct, thus making their removal extremely difficult.…”

Section: 류충헌 등 양성 담도협착에서 완전 피막형 금속 스텐트 삽입의 효과mentioning

confidence: 99%

Temporary Placement of Fully Covered Self-expandable Metal Stents in Benign Biliary Strictures

Ryu

Kim

Lee

et al. 2013

Korean J Gastroenterol

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Background/Aims: Benign biliary strictures (BBSs) have been endoscopically managed with plastic stent placement. However, data regarding fully covered self-expandable metal stents (FCSEMSs) in BBS patients remain scarce in Korea. Methods: Forty-one patients (21 men, 65.9%) with BBSs underwent FCSEMS placement between February 2007 and July 2010 in Asan Medical Center. Efficacy and safety were evaluated retrospectively. Patients were considered to have resolution if they showed evidence of stricture resolution on cholangiography and if an inflated retrieval balloon easily passed through the strictures at FCSEMS removal. Results: The mean FCSEMS placement time was 3.2 (1.9-6.2) months. Patients were followed for a mean of 10.2 (1.0-32.0) months after FCSEMS removal. The BBS resolution rate was confirmed in 38 of 41 (92.7%) patients who underwent FCSEMS removal. After FCSEMS removal, 6 of 38 (15.8%) patients experienced symptomatic recurrent stricture and repeat stenting was performed. When a breakdown by etiology of stricture was performed, 14 of 15 (93.3%) patients with chronic pancreatitis, 17 of 19 (89.5%) with gall stone-related disease, 4 of 4 (100%) with surgical procedures, and 2 of 2 (100%) with BBSs of other etiology had resolution at FCSEMS removal. Complications related to stent therapy occurred in 12 (29%) patients, including post-ERCP pancreatitis (n=4), proximal migration (n=3), distal migration (n=3), and occlusion (n=2). Conclusions: Temporary FCSEMS placement in BBS patients offers a potential alternative to plastic stenting. However, because of the significant complications and modest resolution rates, the potential benefits and risks should be evaluated in further investigations. (Korean J Gastroenterol 2013;62:49-54)

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Section: 류충헌 등 양성 담도협착에서 완전 피막형 금속 스텐트 삽입의 효과mentioning

confidence: 99%

Temporary Placement of Fully Covered Self-expandable Metal Stents in Benign Biliary Strictures

Ryu

Kim

Lee

et al. 2013

Korean J Gastroenterol

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“…Deviere et al [85] deployed USEMS in patients (n = 20) with CP, and initially demonstrated relief of cholestasis for up to 33 mo for 18 patients. Repeat ERCP 3 mo later demonstrated that the stent was embedded within the bile duct wall.…”

Section: Pancreatic Pseudocystsmentioning

confidence: 99%

“…In recent years, EUS-guided pseudocyst (EGPD) drainage has gained in popularity since it allow to avoid intervening vessels and target more challenging collections safely when compared to conventional transmural drainage Sauerbruch et al [107] 8 8 8 11 Den Toom et al [108] 8 8 (7 pain relief) 8 17 Sauerbruch et al [109] 24 24 24 24 Delhaye et al [60] 123 88 123 Schneider et al [110] 50 39 48 20 Van der Hul et al [111] 17 17 17 30 Wolf et al [112] 12 9 12 19-22 Schreiber et al [113] 10 7 10 12 Johanns et al [114] 35 23 16 NA Ohara et al [115] Uncovered metal stents have also been evaluated. Since biliary strictures related to CP can be difficult to treat with plastic stents, there have been several studies that examined the use of uncovered self-expanding metal stents (USEMS) in patients with primarily CP [84][85][86][87] .…”

Section: Pancreatic Pseudocystsmentioning

confidence: 99%

Endoscopic management of chronic pancreatitis

Oza

Kahaleh²

2013

WJGE

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Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

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“…Because plastic stent are not adapted for a long-term drainage, Deviere et al tested metallic expansive stent with an excellent result in 18/20 patients, after 33 mo of follow-up [64] . Nevertheless, the two remaining patients presented an obstruction of the stent secondary to epithelial hyperplasia in contact with the stent.…”

Section: Endoscopic Treatment Of Biliary Stenosismentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis

Heyries¹,

Sahel²

2007

WJG

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Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, n e w i m p r o v e m e n t s w e r e n e c e s s a r y : f a i l u r e s o f pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated. METHODSEndoscopic treatment needs a team (operator, anaesthesiologist) aware with Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Specific material is necessary: good fluoroscopy with the possibility to magnify pictures, and a duodenoscope with a 4.2 channel allowing insertion of high calibre stent (10 Fr). Moreover, a wide variety of endoscopic ancillar y instruments is essential: metallic and hydrophilic guidewire, sphincterotomes, Dormia basket, balloon dilatators and bougie dilatators (5-11.5 Fr), but also very thin guide wire (0.025 inches), fine-tipped sphincterotomes, Soehendra extractors (cf infra) [1] . Impaction of stones in pancreatic ducts needs the use of extracorporeal shock wave lithotripsy before endoscopic stone extraction [2]

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Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents.

Abstract: Twenty patients with chronic pancreatitis and signs of biliary obstruction were treated by endoscopic placement of self expandable metal mesh stents, and followed up prospectively. Eleven had been treated previously with plastic endoprostheses. All

Cited by 161 publications

References 14 publications

Temporary Placement of Fully Covered Self-expandable Metal Stents in Benign Biliary Strictures

Temporary Placement of Fully Covered Self-expandable Metal Stents in Benign Biliary Strictures

Endoscopic management of chronic pancreatitis

Endoscopic treatment of chronic pancreatitis

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