Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis

Abstract

Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective.

Fully covered self-expandable metal stents for treatment of benign biliary strictures

“…7,11,12,20,25,27,28,30,31 Although much variation exists between studies, the most common adverse events described include periprocedural pancreatitis, cholangitis, pain, secondary strictures, and stent migration. Stent migration is discussed separately in the following.…”

Chronic pancreatitis

“…Several studies have shown the efficacy of endotherapy in patients with CP and PD strictures (Table 21.1) [16,[20][21][22][23][24][25][26][27][28][29]. Early series with a single plastic stent (PS) ± stricture dilation reported good short-term pain relief (70-94%).…”

“…During a median follow-up period of 38 months, 84% of patients were pain-free after stent removal. The placement of a self-expandable metal stent (SEMS) has been reported in an attempt to maintain PD patency for a long term and reduce the number of interventions required for benign stricture management [27][28][29][30]. In a study from Brussels with SEMS placement for benign PD obstruction, 20 patients treated with uncovered SEMS (USEMS) had immediate pain relief [30].…”

“…However, stent migration (n = 8) was a main complication in those with PCSEMS or FCSEMS insertion. Recent studies have reported relief of pain in 90-100% of cases while stents were in place and there was resolution of PD strictures in 67-90% of patients treated with temporary FCSEMS [27][28][29]. However, long-term follow-up data are lacking.…”

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

“…2,3 Other emerging indications for the use of FC-SEMS are (but not limited to) post-sphincterotomy bleeding, esophageal variceal bleeding, sealing of a perforation or bile leak and lately treatment of symptomatic biliary and pancreatic duct strictures. 4,5 Temporary placement of FC-SEMS can also be used to treat benign non-obstructive conditions in the GI tract, such as oesophageal and colonic fistulas. 6 In recent years, endoscopic ultrasound (EUS) has emerged as a mainstream therapeutic modality for drainage and fine-needle injection.…”