Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

“…Oh et al 62 reported that stents could easily be removed at a median of 7.5 months after their insertion in all cases without migration during placement, and 13 (86.7%) of the 15 patients who had responded to pancreatic stenting maintained the response during follow-up (median of 47.3 months) after definite stent removal. Tringali et al 63 showed that FCSEMS removability from the painful pancreatic duct was feasible in all cases, and 90% of the patients were asymptomatic after 3 years. In addition, Cahen et al 64 demonstrated the effectiveness of the biodegradable self-expandable stents for fibrotic pancreatic duct stricture.…”

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

“…However, it seems to be able to spare almost all patients who do not respond to single-stent therapy from undergoing surgery. A trial from the same center on the same patient group using fully covered self-expanding metal stents (fcSEMS) in the MPD showed a high frequency of stent migrations as well as de novo strictures arising at the proximal end of the SEMS [79]. Therefore, MPS should be preferred over SEMS treatment in the MPD in CP.…”

No flare(s), no problem: treating recalcitrant pancreatic duct strictures with short fully covered metal stents

“…4 Within this context, several groups have evaluated the use of fully covered selfexpanding metal stents as a salvage maneuver for these strictures. [5][6][7] Although currently available metal stents are designed for biliary indications, limited case series have found high success rates for pancreatic strictures but with the important caveat that randomized studies have not been performed for refractory pancreatic duct strictures.…”

“…Designed to address adverse events related to fully covered metal stents in the pancreatic duct, this stent (8-mm or 10-mm diameter) has rounded margins with no flares at the 2 ends of the stent in an attempt to reduce the risk for the development of de novo stent-induced strictures, which can occur at rates over 25% with metal stents in the pancreas. 5 Furthermore, to reduce the risk of migration, the stent has a central saddle-shaped portion 1 to 3 cm long that is designed to be placed directly across the stricture. Available in lengths of 3 to 7 cm, the stent is short and can be placed intraductally because it contains a lasso system at the distal end of the stent that allows for easy removal.…”

“…In prior studies, stent migration rates have been reported as high as nearly 50%, particularly with shorter stents. 5 Although theoretically this may be due to the central saddle shape of the stent to mold better in addition to the shorter length of this stent, larger studies will be needed to verify the low rate of migration.…”