Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis

Behm, Brian W.; Brock, Andrew; Clarke, Bryan J.; Ellen, Kristi; Dumonceau, Jean‐Marc; Kahaleh, Michel

doi:10.1055/s-0029-1214708

Cited by 97 publications

(72 citation statements)

References 38 publications

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“…Clinically, success was reported in 92% with multiple stents as compared to 24% with single stents. Uncovered SEMS for BBS are not advocated and partially or fully covered SEMS have been used with a success rate of 50%-80% on follow up for 22-28 mo [60,61] . A recently conducted multicenter trial using fully covered SEMS (FCSEMS) in BBS included 127 patients of CP.…”

Section: Chronic Pancreatitis Related Benign Biliary Stricturesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.© 2013 Baishideng. All rights reserved.Key words: Chronic pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic sphincterotomy; Extracorporeal shockwave lithotripsy; Endosonography Core tip: Chronic pancreatitis is a challenge to the therapeutic endoscopist. A patient with chronic pancreatitis can present with ductal calculi, leaks, pseudocysts, strictures, pancreatic malignancy or a biliary obstruction. Endoscopic therapy offers a high rate of success in properly selected patients. It offers many advantages over surgery, which for a long time was considered the gold standard in the treatment of chronic pancreatitis. This chapter deals with the management of chronic pancreatitis associated strictures, calculi, leaks and pseudocysts. The role of endosonography in management of pseudocysts, cannulation of inaccessible ducts and pain relief has also been discussed.Tandan M, Reddy DN. Endotherapy in chronic pancreatitis.

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Section: Chronic Pancreatitis Related Benign Biliary Stricturesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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“…(43) Better success rate was reported in 20 patients with partially covered SEMS for chronic pancreatitis-related biliary strictures. (44) In this study, 18 patients had persistent stricture resolution six months after stent removal. Median stent duration was five months.…”

Section: Semsmentioning

confidence: 73%

Current status of endotherapy for chronic pancreatitis

Kwek

Maydeo²

2014

smedj

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Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.

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“…Treatment with uncovered SEMS is associated with a high long-term morbidity and not recommended. Placement of covered SEMS is an investigational option for CP-related biliary stenosis [86,200,209,210]. Other authors reported that the use of SEMS for long-term stenting of benign biliary strictures due to CP was safe and that it provided successful and prolonged biliary drainage in a selected group of patients in whom surgical intervention was not possible or desirable [211].…”

Section: Cp-related Biliary Stricturesmentioning

confidence: 99%

Endoscopic Treatment of Pancreatic Diseases

Vladimirov¹,

Getzov²,

Ivanova³

2015

Endoscopy - Innovative Uses and Emerging Technologies

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Endoscopic therapy has been increasingly recognized as an effective method of treatment in selected patients with pancreatic diseases. Various endoscopic procedures, classical and modified, are used for the complex treatment of acute and chronic pancreatitis, as well as their complications. In pancreatic carcinoma, some endoscopic methods are applied mainly as palliative measures. There are still open questions regarding the placing and timing of various endoscopic procedures in the multidisciplinary management approach of pancreatic diseases.

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Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis

Cited by 97 publications

References 38 publications

Endotherapy in chronic pancreatitis

Endotherapy in chronic pancreatitis

Current status of endotherapy for chronic pancreatitis

Endoscopic Treatment of Pancreatic Diseases

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