Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience

Abstract

Background and study aims Fully covered self-expanding metal stents (FCSEMS) have been used to treat refractory pancreatic duct strictures. We aimed to evaluate the feasibility, safety, and efficacy of FCSEMS in chronic pancreatitis with refractory pancreatic duct strictures. Patients and methods This was a retrospective multicenter cases series of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement in the main pancreatic duct (MPD) at five tertiary care centers between February 2010 and June 2016. Primary endpoints were technical success, clinical success, and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the pancreatic stricture on ERCP. Results Thirty-three patients with previously drained stents, 76 % of whom were male, underwent ERCP with FCSEMS placement. Mean duration of follow-up was 14 months. All of the patients had prior therapy. The technical success rate for FCSEMS placement was 100 % (n = 33) and the clinical success rate was 93 % (was n = 31). Stents were removed after a median duration of 14.4 weeks. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 1 mm to 4.5 mm ( P < 0.001). There was a statistically significant improvement on the Visual Analogue Scale (VAS) from a median of 8.5 to 2.5. At the end of the study, (n = 27) 87.1 % of patients reported significant pain reduction with reduced narcotic use. Conclusion FCSEMS appeared to be a feasible, safe, and potentially effective Intervention in patients who had not responded to endoscopic therapy with plastic stents.

Cholangiopancreatoscopy-guided laser dissection and ablation for pancreas and biliary strictures and neoplasia

“…In this case series, we demonstrate the potential efficacy of holmium or thulium laser therapy in treating refractory strictures. With regard to pancreatic duct strictures, the use of fully-covered metal stents may provide an effective long-term option, but in addition to cost, are subject to serious AEs including stent migration, stent-induced and non-traversable de novo strictures, and obstruction of the PD side branches, which may result in pancreatic sepsis [12,13]. Furthermore, catheter access across the stenosis is required for dilation and placement of plastic or metal stents.…”

Endoscopic retrograde cholangiopancreatography: Current practice and future research

“…In patients with MPD strictures that remained symptomatic after a single plastic stent who were treated with a 6 mm or 8 mm Niti-S Bumpt Stent (Taewoong Medical, Gimpo-SI, South Korea), 89% of patients were asymptomatic after 3 years. Given the technical success of FCSEMS[ 80 ] and relative safety[ 81 , 82 ], larger studies with long-term data will be performed. An ongoing trial will look at the degree of pain reduction, SAE, and stricture resolution[ 83 ] in patients who received a FCSEMS.…”

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.…”

“…As for the risk of blocking or "jailing" the side branches of the pancreatic duct, this remains a concern with fully covered metal stents; however, recent studies examining these stents in the pancreatic duct have reported low rates of postprocedure pancreatitis or pancreatic sepsis, which raises the question of what role side branch occlusion plays in pain pathogenesis. [5][6][7] Regardless, the short length of these stents minimizes the area of coverage, which may reduce the risk of side branch obstruction.…”