Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Tsuyuguchi, Toshio

doi:10.4253/wjge.v9.i1.12

Cited by 11 publications

(12 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Various stenting durations have not been compared in the literature (scheduled stenting durations with multiple plastic stents and covered SEMSs have generally been for 1 year and for 6 -12 months, respectively). Short biliary strictures may respond better than longer ones to stenting, as suggested by a small study (10 CP patients) [160].…”

Section: Biliary Stricturesmentioning

confidence: 95%

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

et al. 2019

View full text Add to dashboard Cite

Main RecommendationsESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

show abstract

Section: Biliary Stricturesmentioning

confidence: 95%

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

et al. 2019

View full text Add to dashboard Cite

show abstract

“…11 This approach requires an average of 4 to 5 ERCP procedures. 13,14 The need for multiple endoscopic interventions is challenging for patients and reduces compliance. [15][16][17] Given high costs and burden of treatment, a longer-term solution for treating BBSs is desired.…”

mentioning

confidence: 99%

Long-term outcomes after temporary placement of a self-expanding fully covered metal stent for benign biliary strictures secondary to chronic pancreatitis

Lakhtakia

Reddy

Dolak

et al. 2020

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Background and Aims: Temporary single, fully covered self-expanding metal stent (FCSEMS) placement for benign biliary strictures (BBSs) associated with chronic pancreatitis (CP) may require fewer interventions than endotherapy with multiple plastic stents and may carry less morbidity than biliary diversion surgery. This study aimed to assess long-term outcomes in CP-associated BBSs after FCSEMS placement and removal. Methods:In this open-label, multinational, prospective study, subjects with CP and a BBS treated with FCSEMS placement with scheduled removal at 10 to 12 months were followed for 5 years after FCSEMS indwell. Kaplan-Meier analyses assessed BBS resolution and cumulative probability of freedom from recurrent stent placement to 5 years after FCSEMS indwell.Results: One hundred eighteen patients were eligible for FCSEMS removal. At a median of 58 months (interquartile range, 44-64) post-FCSEMS indwell, the probability of remaining stent-free was 61.6% (95% confidence interval [CI], 52.5%-70.7%). In 94 patients whose BBSs resolved at the end of FCSEMS indwell, the probability of remaining stent-free 5 years later was 77.4% (95% CI, 68.4%-86.4%). Serious stent-related adverse events occurred in 27 of 118 patients (22.9%); all resolved with medical therapy or repeated endoscopy. Multivariate analysis identified severe CP (hazard ratio, 2.4; 95% CI, 1.0-5.6; P Z .046) and longer stricture length (hazard ratio, 1.2; 95% CI, 1.0-1.4; P Z .022) as predictors of stricture recurrence. Conclusion:In patients with symptomatic BBSs secondary to CP, 5 years after placement of a single FCSEMS intended for 10 to 12 months indwell, more than 60% remained asymptomatic and stent-free with an acceptable safety profile. Temporary placement of a single FCSEMS may be considered as first-line treatment for patients with CP and BBSs. (Clinical trial registration number: NCT 01014390.) (Gastrointest Endosc 2020;91:361-9.)

show abstract

“…According to Haapamäki et al ., the treatment success rates after 2 years were approximately the same as those in the multiple PSs and CSEMS (90% vs. 92%). One factor that predicts a long stent‐free period after stent removal was a pre‐treatment stricture length of <24 mm . Although stent migration is a concern, involving changing the shape of the FCSEMS, the use of CSEMSs may become the mainstream treatment for benign biliary strictures in the future.…”

Section: Endoscopic Therapy For Benign Biliary Stricturementioning

confidence: 99%

“…One factor that predicts a long stent-free period after stent removal was a pre-treatment stricture length of <24 mm. 49 Although stent migration is a concern, involving changing the shape of the FCSEMS, 50-52 the use of CSEMSs may become the mainstream treatment for benign biliary strictures in the future.…”

Section: Endoscopic Therapy For Benign Biliary Stricturementioning

confidence: 99%

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

Irisawa¹,

Miyoshi

Itoi

et al. 2019

Digestive Endoscopy

View full text Add to dashboard Cite

The development of endoscopic treatment for pancreatobiliary diseases in recent years is remarkable. In addition to conventional transpapillary treatments under endoscopic retrograde cholangiopancreatography (ERCP), new endoscopic ultrasound‐guided therapy is being developed and implemented. On the other hand, due to the development/improvement of various devices such as new metal stents, a new therapeutic strategy under ERCP is also advocated. The present review focuses on recent advances in the endoscopic treatment of pancreatic pseudocysts, walled‐off necrosis, malignant biliary strictures, and benign biliary/pancreatic duct strictures.

show abstract

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Cited by 11 publications

References 24 publications

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Long-term outcomes after temporary placement of a self-expanding fully covered metal stent for benign biliary strictures secondary to chronic pancreatitis

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

Contact Info

Product

Resources

About