Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Testoni, Pier Alberto

doi:10.3748/wjg.v13.45.5971

Cited by 24 publications

(19 citation statements)

References 46 publications

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“…The fact that only external stents demonstrated efficacy in preventing POPF or other related complications post-PJ supports previous hypotheses that the longer external stents prevent either premature stent migration or occlusion, which in theory may be more prevalent with the shorter internal stent [21]. The hypothesis previously put forth by Biehl and Traverso [22].…”

Section: Discussionsupporting

confidence: 81%

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

Prashant¹,

Thoens²,

Mauricio³

et al. 2014

Pancreat Disord Ther

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IntroductionThe National Cancer Institute has estimated that there will be as many as 45,220 new cases of pancreatic cancer in the U.S. in 2012 and that as many as 38,460 patients will die of the disease this year alone [1]. Pancreaticoduodenectomy (PD) remains the sole potentially curative intervention for several types of peri-ampullary and pancreatic carcinomas and pathologies. Postoperative Pancreatic Fistula Formation (POPF) as a result of pancreaticojejunostomy (PJ) anastomotic failure remains one of the most serious and dreaded complications following PD. POPF is believed to be a consequence of pancreatic exocrine secretion seepage across a compromised anastomotic site, with the most likely mechanism being autodigestion and destruction of the tissue surrounding the PJ anastomotic site leading to dehiscence and seepage into the abdominal cavity. The release of these activated pancreatic juices then cause peripancreatic collections, intra-abdominal abscesses, hemorrhage, and POPF [2].Protection of this anastomotic site has therefore been the focus of many modifications to the original Whipple procedure. Stent placement across the PJ anastomsis has been proposed to protect the integrity of the site by diverting the potentially caustic exocrine secretions of the pancreatic remnant away from the delicate anastomotic site. In addition, such stents have been theorized to promote precise placement of anastomotic sutures, facilitate decompression of the pancreatic remnant, and maintain patency of the pancreatic duct postoperatively [3,4].Two similar though uniquely different procedures have been integrated into the traditional PD procedure with varying reports of actual efficacy; an internal and an external pancreatic duct stent. The internal stent technique is generally performed by inserting a 6 cm stent into the pancreatic duct such that one-half of its length remains within the duct itself, bridges across the anastomotic site, and empties into the jejunal lumen. In contrast, the external stent utilizes a longer stent placed similarly within the pancreatic duct stump, bridges across the anastomotic site into the jenual lumen, but the tail of which is exited through a small enterotomy site in the free end of the jejunal loop. This is then closed with a purse-string suture, externalized via a stab incision in the anterior abdominal wall, and closed by suturing the serosa of the jejunum to the peritoneum of the abdominal wall. In both cases migration of the catheter is prevented with an absorbable suture attachment to the jejunal mucosal surface [4][5][6][7][8][9]. The final PJ reconstruction is then carried out with an end-to-side, duct-to-mucosa anastomosis using 1-or 2-layer interrupted fine sutures [6].Previous meta analysis performed by Markar et al. [10] examined the combined effect of placement of either stent type on clinical outcome following PJ. Based on the integrated data sets, these authors identified a non-statistically significant trend towards reduced pancreatic fistula with the use of either sten...

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Section: Discussionsupporting

confidence: 81%

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

Prashant¹,

Thoens²,

Mauricio³

et al. 2014

Pancreat Disord Ther

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“…In patients with chronic pancreatitis and main duct stricture, stent placement achieves resolution of pain in 52%-95% of patients [3,[53][54][55]. In addition to achieving pain control, these studies also illustrated a reduction in pancreatitis related hospital admissions along with improved nutrition and reduction in the severity of exocrine failure [52]. Similar results of pain alleviation with endoscopic stenting of the main pancreatic duct have been reproduced in paediatric patients with recurrent pancreatitis.…”

Section: Endoscopic Managementmentioning

confidence: 90%

“…Obstruction of the main pancreatic duct in itself can also induce recurrent pancreatitis [51]. As the main pancreatic outflow channel is occluded, it is hypothesized that this induces ductal hypertension [52]. This initiates a cascade of events that decreases the blood supply to the acinar cells whereby propagating the inflammatory process and promoting further development of fibrosis [52].…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…As the main pancreatic outflow channel is occluded, it is hypothesized that this induces ductal hypertension [52]. This initiates a cascade of events that decreases the blood supply to the acinar cells whereby propagating the inflammatory process and promoting further development of fibrosis [52]. Pancreatic duct decompression can be achieved with endoscopic intervention with stent placement to alleviate ductal obstruction [3].…”

Section: Endoscopic Managementmentioning

confidence: 99%

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Hereditary Pancreatitis – A Review of Current Concepts and Management

Hughes¹,

Gordon-Weeks²,

Silva³

2019

obm hg

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Background: Hereditary Pancreatitis is a rare cause of acute pancreatitis. These patients usually present at a young age with recurrent episodes of acute pancreatitis that usually progresses to chronic pancreatitis with associated endocrine and exocrine failure. Hereditary pancreatitis also carries an increased lifetime risk of pancreatic adenocarcinoma. These high risk patients need early intervention where appropriate by specialist multidisciplinary teams and tailored long term management. Methods: A review of the relevant literature regarding the epidemiology, the genetic mechanisms responsible for the disease and current management strategies for Hereditary Pancreatitis was performed. Results: Several underlying genetic driver mutations for Hereditary Pancreatitis have been identified, notably PRSS1, SPINK1, CFTR and CRTC mutations. Recurrent episodes of pancreatitis result in a progressive loss of normal pancreatic parenchyma, which is

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“…Patients with stones situated in a dilated pancreatic duct without strictures, stones behind soft strictures or stones associated with pancreas divisum are eligible for endoscopic treatment with ESWL [8]. Patients with distal strictures and upstream dilatations of the pancreatic duct are good candidates for pancreatic stenting [9]. In contrast, patients with strictures or stones situated in a body/tail lesion do not respond as well to endoscopic treatment as to ESWL [8, 10].…”

Section: Indicationsmentioning

confidence: 99%

Endoscopic treatment for chronic pancreatitis: indications, technique, results

Hirota

Asakura

Kanno

et al. 2009

J Hepato Biliary Pancreat

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Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and longterm relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.

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Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Cited by 24 publications

References 46 publications

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

A Meta-Analysis and Systematic Review of Pancreatic Duct Stent

Hereditary Pancreatitis – A Review of Current Concepts and Management

Endoscopic treatment for chronic pancreatitis: indications, technique, results

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