10 Fr S-Type Plastic Pancreatic Stents in Chronic Pancreatitis Are Effective for the Treatment of Pancreatic Duct Strictures and Pancreatic Stones

Aim Endoscopic pancreatic stenting for refractory pancreatic duct strictures associated with impacted pancreatic stones in chronic pancreatitis cases has yielded conflicting results. We retrospectively evaluated the efficacy of endoscopic treatment in chronic pancreatitis patients with pancreatic duct strictures. Methods Pancreatic sphincterotomy, dilatation procedures, pancreatic brush cytology, and pancreatic juice cytology were routinely performed, and malignant diseases were excluded. After gradual dilatation, a 10 Fr plastic pancreatic stent was inserted. The stents were replaced every 3 months and removed after the strictures were dilated. Statistical analyses were performed to determine the risk of main pancreatic duct restenosis. Results Endoscopic pancreatic stents were successfully placed in 41 of a total of 59 patients (69.5%). The median duration of pancreatic stenting was 276 days. Pain relief was obtained in 37 of 41 patients (90.2%). Seventeen patients (41.5%) had recurrence of main pancreatic duct stricture, and restenting was performed in 16 patients (average placement period 260 days). During the follow-up period, pancreatic cancer developed in three patients (5.1%). Multivariate analysis revealed that the presence of remnant stones after stenting treatment was significantly associated with a higher rate of main pancreatic duct restenosis (p = 0.03). Conclusion The use of 10 Fr S-type plastic pancreatic stents with routine exchange was effective for both short-term and long-term outcomes in chronic pancreatitis patients with benign pancreatic duct strictures and impacted pancreatic stones.

[1]  Y. Igarashi,et al.  Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis , 2014, BioMed research international.

[2]  T. Ponchon,et al.  Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline , 2012, Endoscopy.

[3]  S. Atay,et al.  Rapid-infusion rituximab in lymphoma treatment: 2-year experience in a single institution. , 2012, Journal of oncology practice.

[4]  Myung-Hwan Kim,et al.  Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. , 2010, Gastrointestinal endoscopy.

[5]  H. Lee,et al.  Endoscopic Pancreatic Sphincterotomy: Indications and Complications , 2009, The Korean journal of internal medicine.

[6]  Myung-Hwan Kim,et al.  Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic ductal strictures: a pilot study (with video). , 2008, Gastrointestinal endoscopy.

[7]  J. Boursier,et al.  Endoscopic treatment of painful chronic pancreatitis: evaluation of a new flexible multiperforated plastic stent. , 2008, Gastroenterologie clinique et biologique.

[8]  J. Barkin Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis , 2008 .

[9]  C. Prinz,et al.  Endoscopic Stent Therapy For Patients With Chronic Pancreatitis: Results From a Prospective Follow-Up Study , 2007, Pancreas.

[10]  P. Testoni Endoscopic stenting in benign pancreatic diseases. , 2007, JOP : Journal of the pancreas.

[11]  D. Gouma,et al.  Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. , 2005, The New England journal of medicine.

[12]  N. Sasahira,et al.  Outcomes after clearance of pancreatic stones with or without pancreatic stenting , 2007, Journal of Gastroenterology.

[13]  G. Costamagna,et al.  Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial , 2006, Gut.

[14]  Kwi-Sook Choi,et al.  Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones. , 2006, Journal of hepato-biliary-pancreatic surgery.

[15]  G. Costamagna,et al.  Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results. , 2006, Endoscopy.

[16]  Katsushi Seza,et al.  Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis , 2006, Scandinavian journal of gastroenterology.

[17]  E. G. Hahn,et al.  Interventional endoscopic therapy in chronic pancreatitis including temporary stenting: A definitive treatment? , 2006, Scandinavian journal of gastroenterology.

[18]  D. Andersen,et al.  Outcome Following Endoscopic Stenting of Pancreatic Duct Strictures in Chronic Pancreatitis , 2005, Journal of clinical gastroenterology.

[19]  T. Tsuyuguchi,et al.  Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. , 2005, Gastrointestinal endoscopy.

[20]  K. Inui,et al.  SHORT‐TERM METAL STENTING FOR TREATMENT OF MAIN PANCREATIC DUCT STRICTURES ASSOCIATED WITH CHRONIC PANCREATITIS , 2005 .

[21]  E. G. Hahn,et al.  Composition of clogging material in pancreatic endoprostheses. , 2005, Gastrointestinal endoscopy.

[22]  G. Costamagna,et al.  Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct. , 2005, Gastrointestinal endoscopy.

[23]  O. Moine,et al.  Long-Term Outcome after Pancreatic Stenting in Severe Chronic Pancreatitis , 2005, Endoscopy.

[24]  Y. Igarashi,et al.  ENDOSCOPIC PANCREATIC DRAINAGE , 2004 .

[25]  J. Devière,et al.  Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. , 2004, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[26]  G. Larson,et al.  Role of pancreatic duct stenting in the treatment of chronic pancreatitis , 2004, Surgical Endoscopy And Other Interventional Techniques.

[27]  T. Ukita Pancreatic stenting for the preservation of pancreatic function in chronic pancreatitis with stricture , 2003 .

[28]  D. Morgan,et al.  Endoscopic Stent Therapy in Advanced Chronic Pancreatitis: Relationships Between Ductal Changes, Clinical Response, and Stent Patency , 2003, American Journal of Gastroenterology.

[29]  I. Maetani,et al.  Successful management of postoperative pancreatic fistula by application of constructed S-type pancreatic stent after operation for abnormal biliary-pancreatic junction. , 2003, Endoscopy.

[30]  Christoph Bobrowski,et al.  Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis , 2002, American Journal of Gastroenterology.

[31]  N. Soehendra,et al.  Endoscopic Treatment of Chronic Pancreatitis: A Multicenter Study of 1000 Patients with Long-Term Follow-Up , 2002, Endoscopy.

[32]  R. Jakobs,et al.  Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy , 1999, Gut.

[33]  J. Devière,et al.  Expandable metal stents for benign pancreatic duct obstruction. , 1999, Gastrointestinal endoscopy clinics of North America.

[34]  J. Disario,et al.  Dilation of refractory pancreatic duct strictures: the turn of the screw. , 1999, Gastrointestinal endoscopy.

[35]  N. Soehendra,et al.  Stent retriever for dilation of pancreatic and bile duct strictures. brand@uke.uni-hamburg.de. , 1999, Endoscopy.

[36]  J. Devière,et al.  Pancreatic duct stones management. , 1998, Gastrointestinal endoscopy clinics of North America.

[37]  T. Baron,et al.  Dilation of a difficult benign pancreatic duct stricture using the Soehendra stent extractor. , 1997, Gastrointestinal endoscopy.

[38]  C. Bassi,et al.  Pain relapses in the first 10 years of chronic pancreatitis. , 1996, American journal of surgery.

[39]  T. Ponchon,et al.  Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. , 1995, Gastrointestinal endoscopy.

[40]  G. Tytgat,et al.  Long-term results of pancreatic stents in chronic pancreatitis. , 1995, Gastrointestinal endoscopy.

[41]  N. Soehendra,et al.  Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. , 1995, Endoscopy.

[42]  E. G. Hahn,et al.  Piezoelectric shock wave lithotripsy of pancreatic duct stones. , 1994, The American journal of gastroenterology.

[43]  R. Hawes,et al.  The occlusion rate of pancreatic stents. , 1994, Gastrointestinal endoscopy.

[44]  M. Delhaye,et al.  Extracorporeal shock-wave lithotripsy of pancreatic calculi. , 1992, Gastroenterology.

[45]  J. Devière,et al.  Stenting in Severe Chronic Pancreatitis: Results of Medium-Term Follow-Up in Seventy-Six Patients , 1991, Endoscopy.

[46]  P. Lankisch [Chronic pancreatitis]. , 1991, Der Internist.

[47]  N. Soehendra,et al.  New Modalities for Treating Chronic Pancreatitis , 1989, Endoscopy.

[48]  G. Tytgat,et al.  Endoscopic pancreatic drainage in chronic pancreatitis. , 1988, Gastrointestinal endoscopy.