Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy

“…Late complications are stent-related: although stent migration is rare (5%), stent occlusion is very frequently encountered. Ductal lesions after stenting (dilatation, irregularity, stenosis) have been reported in 21%-80% of cases [17] . These lesions are associated with endosonographic parenchymal signs in 68% of cases [18] .…”

Section: Wwwwjgnetcommentioning

confidence: 99%

“…These lesions are associated with endosonographic parenchymal signs in 68% of cases [18] . In fact, in more than half of the cases, stenting-ductal lesions will regress four mo after retrieval of the stent [17] .…”

Section: Wwwwjgnetcommentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis

Heyries¹,

Sahel²

2007

WJG

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Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, n e w i m p r o v e m e n t s w e r e n e c e s s a r y : f a i l u r e s o f pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated. METHODSEndoscopic treatment needs a team (operator, anaesthesiologist) aware with Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Specific material is necessary: good fluoroscopy with the possibility to magnify pictures, and a duodenoscope with a 4.2 channel allowing insertion of high calibre stent (10 Fr). Moreover, a wide variety of endoscopic ancillar y instruments is essential: metallic and hydrophilic guidewire, sphincterotomes, Dormia basket, balloon dilatators and bougie dilatators (5-11.5 Fr), but also very thin guide wire (0.025 inches), fine-tipped sphincterotomes, Soehendra extractors (cf infra) [1] . Impaction of stones in pancreatic ducts needs the use of extracorporeal shock wave lithotripsy before endoscopic stone extraction [2]

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“…These include inward or outward migration of the stent, occlusion, and anatomic changes of the pancreatic duct [45,46] . The latter limits the long-term use of stents in the treatment of benign disorders especially when pancreatic ducts are non-dilated.…”

Section: Complications Of Stent Placementmentioning

confidence: 99%

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Alberto¹,

Testoni²

2007

WJG

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The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS), or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis, and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

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Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy

Cited by 235 publications

References 16 publications

S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

Endoscopic treatment of chronic pancreatitis

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

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