Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis

Ishihara, Takeshi; Yamaguchi, Taketo; Seza, Katsushi; Tadenuma, Hiroshi; Saisho, Hiromitsu

doi:10.1080/00365520500383597

“…T he technical success of endoscopic stricture manipulation can range from 80% to 100% of patients with or without prior pancreatic sphincterotomy. In chronic pancreatitis patients with dominant stricture, pain relief was obtained in 52%-95% of cases over a follow-up ranging from 8 to 72 mo [1,[7][8][9][10][11][12][13][14][15][16][17][18][19] . Stenting was also associated with weight gain and fewer hospital visits.…”

Section: Chronic Pancreatitismentioning

confidence: 99%

“…For transpapillary stenting of a pseudocyst, a double pig-tail stent should be used to prevent displacement outside the cyst cavity. Recently, an S-shaped stent with many side holes has been proposed for MPD stenting in chronic pancreatitis [1] ; this stent is made of ethylene vinyl acetate, which is more flexible than polyethylene. The S-shape enables the stent to adapt better to the course of the MPD and reportedly achieves a better outcome in patients with chronic pancreatitis and upstream duct dilatation than in patients treated with the standard straight polyethylene stents ( Figure 3).…”

Section: Technique Of Pancreatic Stent Placementmentioning

confidence: 99%

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Testoni¹

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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“…However with the preexisting fibrosis of MPD there has been no significant clinical impact. The search for an ideal pancreatic stent continues and a new "wing stent" to prevent clogging as well as an "S" shaped stent to prevent migration are undergoing evaluation [32,33] . The use of covered metal stents (CSEMS) for pancreatic strictures is also under evaluation.…”

Section: Endoscopic Management Of Pancreatic Ductal Stricturesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

¹

,

Reddy²

2013

WJG

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Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.© 2013 Baishideng. All rights reserved.Key words: Chronic pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic sphincterotomy; Extracorporeal shockwave lithotripsy; Endosonography Core tip: Chronic pancreatitis is a challenge to the therapeutic endoscopist. A patient with chronic pancreatitis can present with ductal calculi, leaks, pseudocysts, strictures, pancreatic malignancy or a biliary obstruction. Endoscopic therapy offers a high rate of success in properly selected patients. It offers many advantages over surgery, which for a long time was considered the gold standard in the treatment of chronic pancreatitis. This chapter deals with the management of chronic pancreatitis associated strictures, calculi, leaks and pseudocysts. The role of endosonography in management of pseudocysts, cannulation of inaccessible ducts and pain relief has also been discussed.Tandan M, Reddy DN. Endotherapy in chronic pancreatitis.

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“…In chronic pancreatitis patients with dominant stricture, pain relief was obtained in 52%-95% of cases over a follow-up ranging from 8 to 72 mo [1,[7][8][9][10][11][12][13][14][15][16][17][18][19] . Stenting was also associated with weight gain and fewer hospital visits.…”

Section: Chronic Pancreatitismentioning

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.

show abstract

Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis

Abstract: In view of its long durability as a stent and no migration, the s-stent is safe and useful for the management of pancreatic ductal strictures in patients with chronic pancreatitis.

Cited by 54 publications

References 28 publications

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Endotherapy in chronic pancreatitis

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

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