Placement of duodenal stents across the duodenal papilla may predispose to acute pancreatitis: a retrospective analysis

Liu, Shi-Yi; Ai-wu, Mao; Jia, Yiping; Wang, Zhenlei; Jiang, Hao-Sheng; Yin, Xinmin

doi:10.4261/1305-3825.dir.5045-11.1

Cited by 15 publications

(21 citation statements)

References 21 publications

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“…Heterogeneity of SEMS dysfunction rates between RCT and retrospective studies might also be explained by treatment selection bias. Covered SEMS placement across the ampulla may predispose patients to risk of cholangitis or pancreatitis as a result of obstruction of the orifice and was likely avoided . Indeed, among the included RCT, three included gastric cancer patients only, and one excluded patients with duodenal obstruction involving the periampullary lesion .…”

Section: Discussionmentioning

confidence: 99%

“…SEMS‐related GI perforation may be as a result of contact of a SEMS edge, secondary SEMS placement, migration of a SEMS or its fracture, placement of multiple SEMS in a single session, and so forth . The covering membrane along with mechanical compression to the ampulla by SEMS may cause obstructive jaundice, cholangitis, or pancreatitis . In addition, non‐resectable malignant GOO is often complicated by biliary obstruction as a result of tumor involvement .…”

Section: Discussionmentioning

confidence: 99%

“…In cases with a biliary stent in situ , duodenal tumor invasion can be a risk factor for biliary stent dysfunction as a result of enhanced duodenobiliary reflux . Given the feasibility of endoscopic ultrasound‐guided transmural biliary drainage including choledochoduodenostomy and hepaticogastrostomy in patients with an indwelling duodenal SEMS, concern with biliary obstruction might be minimal in current clinical practice, but attention should be paid to avoid SEMS‐related pancreatitis …”

Section: Discussionmentioning

confidence: 99%

“…Covered SEMS placement across the ampulla may predispose patients to risk of cholangitis or pancreatitis as a result of obstruction of the orifice and was likely avoided. 40,[48][49][50] Indeed, among the included RCT, three included gastric cancer patients only, 16,17,24 and one excluded patients with duodenal obstruction involving the periampullary lesion. 25 Retrospective series suggested that SEMS placement apart from the ampulla (the gastric outlet or distal duodenum) might be associated with a higher risk of stent migration or occlusion compared with SEMS placement across the ampulla.…”

Section: Gastroduodenal Sems Dysfunctionmentioning

confidence: 99%

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Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Hamada

Hakuta

Takahara

et al. 2017

Digestive Endoscopy

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Background and Aim: Self-expandable metal stents (SEMS) are used for non-resectable malignant gastric outlet obstruction (GOO). Studies of covered versus uncovered SEMS have yielded inconsistent results as a result of heterogeneity in design and patient population. We carried out a meta-analysis to compare covered and uncovered gastroduodenal SEMS.Methods: Using MEDLINE, Embase, and the Cochrane database, we identified 1624 patients from 13 prospective and retrospective studies that evaluated covered and uncovered SEMS for malignant GOO and were published until October 2016. We pooled data on SEMS dysfunction, technical and clinical success, and adverse events using the fixed-effect or random-effects model. Conclusions: Outcomes of covered and uncovered gastroduodenal SEMS were comparable, although the lower dysfunction rate of covered SEMS observed in the analysis of randomized trials needs further investigation. Antimigration mechanisms for covered SEMS and identification of patients who can achieve longer patency from uncovered SEMS would help improve the outcomes of gastroduodenal SEMS. Results

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Gastroduodenal Sems Dysfunctionmentioning

confidence: 99%

See 2 more Smart Citations

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Hamada

Hakuta

Takahara

et al. 2017

Digestive Endoscopy

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“…The position of placement of a SEMS is sometimes associated with adverse events. Liu et al reported the rate of acute pancreatitis in patients undergoing SEMS placement across the duodenal papilla at the rate of 11% (9/35) (22). Multivariate analysis revealed that the presence of a stent bridging the duodenal papilla [odds ratio (OR) =18.48; 95% CI, 2.298-148.48; P=0.006] was an independent predictor of acute pancreatitis.…”

Section: Adverse Eventsmentioning

confidence: 99%

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

2017

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Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses.Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved.Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.

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Uncovered versus covered expandable metal stents for malignant gastric outlet obstruction caused by intrinsic and extrinsic tumors: meta-analysis and meta-regression analysis

Tamura

Shimokawa²,

Yamashita³

et al. 2022

Surg Endosc

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Placement of duodenal stents across the duodenal papilla may predispose to acute pancreatitis: a retrospective analysis

Cited by 15 publications

References 21 publications

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

Uncovered versus covered expandable metal stents for malignant gastric outlet obstruction caused by intrinsic and extrinsic tumors: meta-analysis and meta-regression analysis

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