Feasibility and safety of a novel plastic stent designed specifically for endoscopic ultrasound-guided pancreatic duct drainage

Abstract

Background and study aims Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is emerging as an effective alternative treatment for obstructive pancreatitis after unsuccessful endoscopic retrograde pancreatography (ERP). However, the high incidence of adverse events associated with EUS-PD (approximately 20%) remains an issue. Recently, we developed a novel plastic stent for EUS-PD, with a radiopaque marker positioned at approximately one-third of the length from the distal end of the stent and side holes positioned exclusively distal to the marker. This study aimed to evaluate the feasibility and safety of using this stent in EUS-PD.

Patients and methods We retrospectively reviewed data from 10 patients who underwent EUS-PD with the novel plastic stent at the National Cancer Center Hospital between March 2021 and October 2023. Technical and clinical success, procedure times, adverse events (AEs), recurrent pancreatic duct obstruction (RPO), and time to RPO were assessed.

Results Of the 10 patients, five had postoperative benign pancreaticojejunal anastomotic strictures and five had malignant pancreatic duct obstruction. The technical and clinical success rates were both 100% (10/10). An AE (self-limited abdominal pain) occurred in one patient (10.0%). Two patients (20.0%) died of their primary disease during the follow-up period (median, 44 days; range, 25–272 days). The incidence of RPO was 10.0% (1/10), and the 3-month non-RPO rate was 83.3%.

Conclusions The novel plastic stent shows potential as a useful and safe tool in EUS-PD.

Keywords

Pancreatobiliary (ERCP/PTCD) - Strictures - Endoscopic ultrasonography - Pancreas - Intervention EUS

Publikationsverlauf

Eingereicht: 16. Dezember 2023

Angenommen nach Revision: 15. Februar 2024

Accepted Manuscript online:
26. März 2024

Artikel online veröffentlicht:
04. Juni 2024

• References

• 1 Bor R, Madácsy L, Fábián A. et al. Endoscopic retrograde pancreatography: when should we do it?. World J Gastrointest Endosc 2015; 7: 1023-1031
• 2 Sanders DJ, Bomman S, Krishnamoorthi R. et al. Endoscopic retrograde cholangiopancreatography: current practice and future research. World J Gastrointest Endosc 2021; 13: 260-274
• 3 Kahaleh M, Hernandez AJ, Tokar J. et al. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 2007; 65: 224-230
• 4 Tyberg A, Sharaiha RZ, Kedia P. et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 2017; 85: 164-169
• 5 Sakai T, Koshita S, Kanno Y. et al. Early and long-term clinical outcomes of endoscopic interventions for benign pancreatic duct stricture/obstruction-the possibility of additional clinical effects of endoscopic ultrasonography-guided pancreatic drainage. Pancreatology 2022; 22: 58-66
• 6 Fujii LL, Topazian MD, Abu Dayyeh BK. et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc 2013; 78: 854-864.e1
• 7 Matsunami Y, Itoi T, Sofuni A. et al. Evaluation of a new stent for EUS-guided pancreatic duct drainage: long-term follow-up outcome. Endosc Int Open 2018; 6: E505-E512
• 8 Oh D, Park DH, Cho MK. et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc 2016; 83: 366-373.e2
• 9 Uchida D, Kato H, Saragai Y. et al. Indications for endoscopic ultrasound-guided pancreatic drainage: for benign or malignant cases?. Can J Gastroenterol Hepatol 2018; 2018: 8216109
• 10 Chen YI, Levy MJ, Moreels TG. et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85: 170-177
• 11 Dalal A, Patil G, Maydeo A. Six-year retrospective analysis of endoscopic ultrasonography-guided pancreatic ductal interventions at a tertiary referral center. Dig Endosc 2020; 32: 409-416
• 12 Chandan S, Mohan BP, Khan SR. et al. Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): a systematic review and meta-analysis of 714 patients. Endosc Int Open 2020; 8: E1664-E1672
• 13 Bhurwal A, Tawadros A, Mutneja H. et al. EUS guided pancreatic duct decompression in surgically altered anatomy or failed ERCP – a systematic review, meta-analysis and meta-regression. Pancreatology 2021; 21: 990-1000
• 14 Kurihara T, Itoi T, Sofuni A. et al. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc 2013; 25: 109-116
• 15 Hijioka S, Sakamoto Y, Nagashio Y. et al. Novel and safe plastic stent exchange method after endoscopic ultrasound-guided hepaticogastrostomy with incomplete fistula (side hole method). Endosc 2023; 55: E24-E25
• 16 Isayama H, Hamada T, Yasuda I. et al. Tokyo criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
• 17 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 18 François E, Kahaleh M, Giovannini M. et al. EUS-guided pancreaticogastrostomy. Gastrointest Endosc 2002; 56: 128-133
• 19 Tessier G, Bories E, Arvanitakis M. et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007; 65: 233-241
• 20 Ergun M, Aouattah T, Gillain C. et al. Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy 2011; 43: 518-52