Clin Endosc.  2022 Nov;55(6):793-800. 10.5946/ce.2021.211.

A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures

• Shah BB
• Rodge GA
• Goenka U
• Afzalpurkar S
• Goenka MK

• KMID: 2536080
• DOI: http://doi.org/10.5946/ce.2021.211

Abstract

Background/Aims
Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
Methods
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Results
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
Conclusions
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

Keyword

Efficacy; Feasibility; Fully covered self-expanding metal stents; Refractory pancreatic duct strictures; Safety

Figure

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  Fig. 1. (A) Pancreatogram obtained before placement of the metal stent showing a tight stricture in the head of the pancreatic duct. (B) Dilatation of pancreatic duct stricture by the hydrostatic balloon. (C) Pancreatogram after Niti-S [Bumpy] stent deployment. (D) Follow-up pancreatogram at 3 months showing resolution of the pancreatic duct stricture.

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  Fig. 2. (A) Occurrence of a de novo pancreatic duct stricture after stent removal. (B) Placement of a plastic pancreatic duct stent across the stricture.

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