Post written by Andrea Tringali, MD, PhD, from the Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Catholic University, and CERTT, Centre for Endoscopic Research, Therapeutics and Training – Catholic University, Rome, Italy.
Pancreatic duct drainage by ERCP and insertion of plastic stents is effective in the treatment of pain related to chronic pancreatitis. The main limitation of pancreatic duct drainage with a single plastic stent is the need for repeated ERCPs for stent exchange and the low rate of stricture resolution. Use of multiple plastic stents has good results in pancreatic duct stricture resolution, but it is also technically demanding.
The focus of our study was the evaluation of fully covered metal stents (FC-SEMSs) to obtain a permanent dilatation of the pancreatic duct stricture after its removal. The main advantage of FC-SEMSs is the possibility to obtain pancreatic duct stricture dilatation with only 2 endoscopic procedures. Few data are available on the safety and efficacy of pancreatic FC-SEMSs.
We conducted a prospective, single-center evaluation of the pancreatic “Bumpy” FC-SEMSs in 15 consecutive patients. FC-SEMS removability 6 months after placement was possible in all cases. Pancreatic duct strictures were successfully dilated in 93% of the cases, and 89% were pain free after more than 3-years follow-up. FC-SEMS migration occurred in 46% of the cases (but was symptomatic in one-third of the patients). FC-SEMS induced stricture was diagnosed in 27% of patients and was successfully re-treated by plastic stent insertion.
Our results confirm the promising results of pancreatic FC-SEMSs in obtaining pancreatic duct stricture resolution in the setting of CP after a 3-year mean follow-up. FC-SEMS migration is still an issue; unfortunately, the custom-made 3-cm long stent that we used in our study had a very high migration rate. FC-SEMS induced strictures is another problem which seems related to the pressure of the flared end of the stent.
Pancreatic FC-SEMSs are easily removable and have promising clinical results after a medium-term follow-up, but new FC-SEMS designs are expected to prevent migration and the occurrence of “de novo” pancreatic duct strictures. We still believe that pancreatic metal stents need further evaluation in the setting of clinical trials.
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