Risk factors for pancreatitis following transpapillary self-expandable metal stent placement

Abstract

SEMSs with high axial force and an etiology of MBO other than pancreatic cancer were strongly associated with a high incidence of pancreatitis following transpapillary SEMS placement in patients with distal MBO.

No Benefit of Endoscopic Sphincterotomy Before Biliary Placement of Self-Expandable Metal Stents for Unresectable Pancreatic Cancer

“…There are 2 possible explanations for the lack of protective effect: the expansive force of the SEMS may be so strong that ES cannot protect the pancreatic orifice, and/ or the axial (straightening) force of the SEMS may directly affect the pancreatic orifice rather than being limited to the incised duodenal mucosa as previously reported. 19,20 The rates of perforation and bleeding in the ES group were only 0% and 1%, respectively, and were comparable with previously reported rates for covered SEMS (0%-0.7% and 0%-2%, respectively). 4,5,[7][8][9][11][12][13][14][15] These rates are relatively low compared with those for ES for extraction of bile duct stones, and this may be attributable to the wrapping and tamponade effect of covered SEMS because the covering membrane may seal tiny perforations and other minor vessel injuries that occur during ES.…”

Suprapapillary versus Transpapillary Stent Placement for Malignant Biliary Obstruction: Which Is Better?

“…However, no significant differences were observed between covered and uncovered SEMSs in the incidence of pancreatitis in two published meta-analyses (20,21) and or the present study. In addition, Kawakubo et al (6) stated that SEMSs with high axial force (defined as recovery force to ensure that the stent returns back straight after bending) are significantly correlated with a high incidence of pancreatitis. However, mechanical characteristics of SEMSs were not measured in the present study.…”

“…Stent-related cholangitis was defined as a condition that included fever exceeding 381C, leukocytosis, and an elevated C-reactive protein level associated with abdominal pain, without other evidence of infections (2). Pancreatitis was diagnosed according to consensus criteria: new or worsening abdominal pain persisting for at least 24 hours and requiring analgesics after SEMS placement with an increase in serum amylase or lipase level greater than three times the upper limit of normal (6). The duration of stent patency was defined as the interval between stent placement and the recurrence of obstructive jaundice.…”

Comparison of partially covered nitinol stents with partially covered stainless stents as a historical control in a multicenter study of distal malignant biliary obstruction: the WATCH study

“…The rate of pancreatitis was higher in patients with nonpancreatic cancer (14% vs 3%; P ϭ .029), which was similar to the previous reports. 10,33 We speculate that in patients with pancreatic cancer, chronic obstruction of the pancreatic duct by cancer causes atrophy of pancreatic parenchyma and exocrine insufficiency, which reduces the risk of pancreatitis.…”