Placement of a 6 mm, fully covered metal stent for main pancreatic head duct stricture due to chronic pancreatitis: a pilot study (with video)

Abstract

Background:Temporary stent placement is widely performed for pancreatic duct stenosis due to chronic pancreatitis. A fully covered self-expandable metal stent (FCSEMS) has a larger diameter, and therefore longer stent patency, and the effect of expansion of the main pancreatic duct stricture may be obtained. However, if stent migration upstream occurs, stent removal is extremely difficult. In addition, because of the diameter gap between the FCSEMS and the main pancreatic duct, stent-induced ductal change may occur. To prevent these adverse events, the technical feasibility, safety and efficacy of the placement of a novel 6 mm diameter FCSEMS with a long suture, to facilitate its removal in cases of stent migration upstream, were evaluated in a pilot study.Methods:Between December 2014 and August 2015, symptomatic chronic pancreatitis patients with abdominal pain and a main pancreatic head duct stricture were enrolled. Stent placement for main pancreatic duct stricture was performed under endoscopic retrograde cholangiopancreatography (ERCP) guidance and stent removal was performed within 6 months.Results:A total of 13 patients were retrospectively enrolled in this study. Metal stent insertion was successfully performed in all patients and clinical success was high (12/13, 92%). As adverse events, stent migration upstream was seen in two patients. Another 11 patients successfully underwent stent removal without any adverse events. During follow up (median 258 days), 2 patients still underwent pancreatic duct stenting because of continuing main pancreatic duct stricture.Conclusion:In conclusion, this novel FCSEMS is acceptable for stent placement in cases of chronic pancreatitis with a main pancreatic duct stricture.

Metal stents placement for refractory pancreatic duct stricture in children

“…The disadvantages of PSs include migration and occlusion by sludge, resulting in necessary replacement at around 3 mo[ 17 ]. In a previous study, FCSEMSs in the management of MPD stricture showed efficacy and safety at 6-mo intervals in adults[ 16 ]. We suggest that our short-term outcomes are similar to the results for adults in terms of the improvement of strictures and the safety of the procedure[ 17 ].…”

“…Repositioning was carried out until the stent was fully inflated and placed in the targeted location. On the basis of previous studies in adults[ 16 ], stent removal was planned with rat-tooth forceps at 6 mo after placement, unless adverse events or episodes of pancreatitis had occurred. Informed consent was obtained from the parents of the patients, after the risks and benefits of the procedure and alternative treatments were explained.…”

Biodegradable pancreatic stent: A 1-step “magical” procedure to resolve pancreatic duct strictures?

“…17 For refractory MPD stricture, the temporary insertion of FC-SEMS could be an option; pain improvement was reported in 52 of 61 (85%) patients in a systematic review of 4 case series but with a short follow-up time after stent removal. 18 Less encouraging results with the need of early FC-SEMS removal and a 63% recurrence rate of symptoms were recently reported in 2 small studies, 19,20 migration and stent-induced MPD stenosis (at the proximal edge of the stent) being the major matters of concern.…”

“…The most worrying adverse event, in our opinion, is, however, the occurrence of a new stricture, proximal to the stent, a feature similar to the previously reported stenosis at the proximal edges of FC-SEMSs. [18][19][20] The advantage of this new stent might be to obviously simplify MPD stricture calibration in painful CP. It seems premature to qualify the results as promising (as compared with the standard policy of single or multiple PPS placement), given the observed clinical outcome and adverse events.…”

Innovation in Pancreatic Stents

“…The most suitable diameter for conventional selfexpandable metal stents (SEMS) remains unclear. We have previously evaluated the clinical feasibility of placing a 6-mm FCSEMS for main pancreatic head duct stricture due to CP [12]. We placed this stent in 13 patients, achieving 100% technical success without any severe adverse events.…”