Endoscopy 2018; 50(06): 597-605
DOI: 10.1055/s-0043-123575
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Early removal of biflanged metal stents in the management of pancreatic walled-off necrosis: a prospective study

Vinay Dhir
1  Baldota Institute of Digestive Sciences, Mumbai, India
,
Douglas G. Adler
2  University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, Utah, United States
,
Ankit Dalal
1  Baldota Institute of Digestive Sciences, Mumbai, India
,
Nitin Aherrao
1  Baldota Institute of Digestive Sciences, Mumbai, India
,
Rahul Shah
1  Baldota Institute of Digestive Sciences, Mumbai, India
,
Amit Maydeo
1  Baldota Institute of Digestive Sciences, Mumbai, India
› Author Affiliations
Further Information

Publication History

submitted 06 June 2017

accepted after revision 02 November 2017

Publication Date:
22 December 2017 (eFirst)

Abstract

Background and study aims Dedicated stents placed under endoscopic ultrasound (EUS) guidance have shown promise for the management of pancreatic walled-off necrosis (WON). A long duration of stent placement may increase the risk of adverse events. We prospectively evaluated the effects of (i) early removal of biflanged metal stents (BFMSs) and (ii) additional stenting of the pancreatic duct with plastic stents in patients with ductal leaks, on the risk of WON recurrence.

Patients and methods Symptomatic patients with pancreatic WON underwent EUS-guided BFMS placement, followed by necrosectomy, when required, from Day 3. A 5 Fr plastic stent was placed in patients with ductal leak. BFMS was removed when the WON cavity had collapsed completely. Patients were followed up at 3-month intervals.

Results BFMS placement was successful in all 88 patients. A total of 64 patients (72.7 %) underwent necrosectomy (median 3 sessions). All BFMSs were removed at a median of 3.5 weeks (range 3 – 17 weeks). Ductal disconnection and leak occurred in 53/87 (60.9 %) and 61/87 (70.1 %) patients, respectively. A 5 Fr stent was placed in 56/61 patients (91.8 %) with ductal leak. Overall, 22 patients (25.0 %) had adverse events (17 mild, 1 moderate, 3 severe, 1 fatal). Recurrence was noted in 8/88 (9.1 %) at a median follow-up of 22 months. The recurrence rate was higher in patients with ductal disconnection than in those without (13.2 % vs. 2.9 %; P = 0.08), and was similar in patients with vs. without pancreatic duct stenting (7.1 % vs. 12.9 %; P = 0.44). Seven recurrences (87.5 %) partially regressed on follow-up and did not require therapy; in one case, drainage with a plastic stent was performed.

Conclusions Short-term BFMS placement is an effective therapy for pancreatic WON. The majority of recurrences developed in patients with ductal disconnection and did not require therapy. Additional pancreatic duct stents probably do not influence the recurrence rate.