Pancreatic stent placement for duct disruption

Practice Guidelines in Acute Pancreatitis

“…Endoscopic treatment of a pancreatic duct leak includes placement of a pancreatic stent, preferably bridging the leak when the main pancreatic duct is in continuity (200)(201)(202). Endoscopic pancreatic duct stent placement in the setting of organized necrosis or larger or debris-filled pseudocysts should generally be accompanied by direct drainage of the necrotic cavity by another route as already described; placement of pancreatic stents alone during acutely evolving pancreatic necrosis is considered experimental at the current time, with concern about colonization with bacteria and infection of otherwise sterile necrosis (203).…”

“…Endoscopic pancreatic duct stent placement in the setting of organized necrosis or larger or debris-filled pseudocysts should generally be accompanied by direct drainage of the necrotic cavity by another route as already described; placement of pancreatic stents alone during acutely evolving pancreatic necrosis is considered experimental at the current time, with concern about colonization with bacteria and infection of otherwise sterile necrosis (203). Closure of duct leaks with stents is successful in about two-thirds to three-quarters of cases, depending on a number of factors including site and size of duct disruption, superinfection, downstream obstruction as a consequence of pancreatic stricture or stone, whether the leak can be bridged, and the presence of the "disconnected duct syndrome" (200)(201)(202). Closure of refractory pancreatic fistulas by injection of cyanoacrylate glue by endoscopic or percutaneous routes has been reported (196).…”

Conservative and surgical management of pancreatic trauma in adult patients

“…Monitoring CT scan on the 7 th day of hospitalization did not find any abdominal fluid collection in 10 patients. Two patients died within 24 hours of Isolated pancreatic trauma 2 [7] Duodenum injury 2 [7] Digestive tract injury other than duodenum 8 [27] Liver and spleen injury 4 [13] Vascular injury 6 [19] Extra-abdominal injury 13 [43] SD, standard deviation; AAST, American Association for Surgery of Trauma.…”

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

“…A: Contrast injection into the MPD shows a stricture of the main pancreatic duct at the level of the cyst; B: After pancreatic sphincterotomy, the stricture is dilated, a guidewire is inserted into the cyst cavity, and a plastic stent is placed; C and D: Under EUS guidance, a double pig-tail plastic stent is also placed by a single step procedure; D: X-ray imaging shows trans-papillary and trans-gastric stents at the end of the procedure. the leakage or distally were more often associated with approximately 50% of failures [41] . A partially disrupted MPD, the location of the disruption at the level of the body of the pancreas, the stent positioned to bridge the disruption, and a longer duration of stent therapy were identified as predictors of a favorable outcome in the endoscopic management of duct disruption on a large series of patients [39] .…”

“…The stent should be left in place for four to six weeks. A shorter period of stenting may involve a higher rate of failure [41] , while a longer period may increase the risk of stent occlusion and stent-induced alterations in ductal morphology.…”