Endosc Int Open 2016; 04(11): 1215-1222
DOI: 10.1055/s-0042-115934
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Prospective pilot study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: long-term outcomes

Saburo Matsubara
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Naoki Sasahira
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Hiroyuki Isayama
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Naminatsu Takahara
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Suguru Mizuno
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Hirofumi Kogure
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Natsuyo Yamamoto
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Yousuke Nakai
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Minoru Tada
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
,
Kazuhiko Koike
Graduate School of Medicine, The University of Tokyo – Gastroenterology, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted25 January 2016

accepted after revision01 August 2016

Publication Date:
10 November 2016 (online)

Background and study aims: Temporary placement of a fully covered self-expandable metal stent (FCSEMS) has recently emerged as a treatment option for pancreatic duct strictures due to chronic pancreatitis refractory to conventional plastic stenting. However, there are no data about long-term outcomes with this therapeutic option. The aims of the current study were to estimate the feasibility, safety, efficacy, and long-term outcomes of temporary FCSEMS placement for refractory pancreatic duct strictures.

Patients and methods: This was a prospective, single-center feasibility study. Ten patients with refractory pancreatic duct strictures due to chronic pancreatitis underwent FCSEMS placement for 3 months. We evaluated the rate of recurrent symptoms after stent removal during long-term follow-up, as well as adverse events (AEs).

Results: Two patients required early (within 1 week) stent removal because of intolerable pain or pancreatitis. In the remaining 8 patients, the recurrence rate of any symptoms after FCSEMS removal was 63% during 35 months of follow up. The causes of recurrent symptoms were as follows: recurrence of stricture in 2; stent-induced stricture in 1; impaction of pancreatic stones in 1; and development of a pseudocyst in 1. When limited to stricture, the recurrence rate was 38%. Additional endoscopic treatments were required in 4 patients: a second FCSEMS placement in 1; plastic stent (PS) placement in 1; stone extraction in 1; and endoscopic ultrasound–guided pseudocyst drainage in 1. Asymptomatic stent migration occurred in 2 patients. Suppurative pancreatic ductitis due to food impaction in the FCSEMS occurred in 2 patients, and endoscopic pancreatic duct drainage was performed. Stent-induced ductal changes developed in 2 patients and PS treatment was required in 1 patient for pain relief.

Conclusion: The FCSEMS appears to be a feasible and potentially effective option for the management of refractory pancreatic duct strictures due to chronic pancreatitis during long-term follow-up. AEs including post-procedure pain, stent-induced ductal changes, migration, and ductitis are issues that need to be resolved.

 
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