Biodegradable Pancreatic and Biliary Stents—Still Searching For Disappearing Wonder?

Daniel, Philip B.; Rana, Surinder Singh

doi:10.1055/s-0040-1713712

Cited by 4 publications

(4 citation statements)

References 14 publications

(17 reference statements)

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“…58 The stent used in this series was originally designed for endoscopic application and was evaluated in both biliary and pancreatic applications. 30,59 Biodegradable stents were initially used in vascular and urological applications, then in stenting esophageal strictures. They soon found use in percutaneous and endoscopic management of bile duct disease, as an alternative to plastic and metallic stents, with the significant advantage of avoiding repeat interventions for removal or exchange.…”

Section: Discussionmentioning

confidence: 99%

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USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

et al. 2022

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Background. Plastic stents have been used to avoid postoperative pancreatic fistula (POPF) following Whipple’s Pancreaticoduodenectomy (WPD), but they may cause some stent-related complications. Biodegradable stents have been recently introduced and might be a safe alternative. Here we present our initial experience with their use. Methods. Between March 1, 2020, and September 30, 2020, ten (10) consecutive patients underwent WPD. They all had conventional two-layer pancreaticojejunostomy with the placement of an internal biodegradable stent. They were assessed for technical feasibility, pancreatic leak, and stent-related complications. Results. The use of biodegradable stents was technically feasible in all patients, despite some difficulties in insertion due to stent stiffness and design. After a median follow-up period of 124 days, none of the patients suffered POPF. One patient had a biochemical pancreatic leak with no clinical significance. The median hospital stay was 7 days, and there were no stent-related complications. Conclusion. Biodegradable stents are technically feasible and safe in WPD with good short-term outcomes. They might provide a better alternative to plastic stents and their potential complications. Larger long-term studies are needed to validate efficacy and safety. Few modifications of the stent’s design might be needed to facilitate use in open surgery.

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Section: Discussionmentioning

confidence: 99%

“…58 The stent used in this series was originally designed for endoscopic application and was evaluated in both biliary and pancreatic applications. 30,59…”

Section: Discussionmentioning

confidence: 99%

USE of Biodegradable STENTS in Pancreaticoduodenectomy: Initial Experience

et al. 2022

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“… 79 , 80 Undoubtedly, the most valuable advantages of biodegradable stents are the avoidance of a later ERCP to remove them and the permanence inside the pancreatic duct for a sufficient period of time before degradation to guarantee pancreatic drainage. 81 Whether the degradation of pancreatic stents could lead to the presence of stent fragments into a normal pancreatic duct with subsequent sequelae is not known; therefore, randomized controlled trials comparing outcomes of pancreatic biodegradable stents versus conventional stents positioning are warranted to define the best setting in which using this novel device. Moreover, high costs of biodegradable stents is a limitation to their use in clinical practice ( Figure 4 ).…”

Section: Technical Expedients and Pharmacological Measures In The Pre...mentioning

confidence: 99%

Prevention of post-ERCP pancreatitis: current strategies and novel perspectives

Andreis

Mascagni

Schepis

et al. 2023

Therap Adv Gastroenterol

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Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist’s technical abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP.

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“…The spontaneous resorbability would be an attractive option in patients with poor follow-up, and the possibility of stent migration is reduced, too. 23 However, they need to meet the stringent mechanical properties for at least eight weeks post-implantation to seal the anastomosis and be flexible enough for easy implantation. More importantly, they must fully resorb in approximately six months without triggering an excessive inflammatory response via degradation products.…”

Section: Next-generation Stentsmentioning

confidence: 99%