Pancreatic Duct Stenting: Does Interventional Radiology Have a Role?

Abstract

Pancreatic duct stenting involves the placement of a stent into the pancreatic duct to restore drainage and flow of pancreatic secretions. It relieves upstream duct dilation, facilitates drainage of pancreatic secretions, and alleviates associated symptoms like pain, nausea, malnutrition, and recurrent pancreatitis. Additionally, it is utilized to treat a variety of pancreatic duct pathologies, including obstructions from conditions like chronic pancreatitis, malignancy, and pancreatic leaks. Depending on the clinical scenario, different types of stents can be placed using endoscopic, percutaneous, or surgical approaches. Endoscopic approaches, such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided stenting, are often considered first-line procedures for managing pancreatic duct pathologies. However, in cases where these procedures fail, interventional radiology (IR) becomes crucial in managing these conditions, providing a safe and minimally invasive alternative that effectively addresses the underlying issues. This review aims to discuss the clinical, radiological, and technical considerations for pancreatic duct stenting and specifically highlight the role of IR in managing various pancreatic duct pathologies.

Keywords

pancreatic duct stenting - endoscopic ultrasound - percutaneous pancreatic interventions

Publikationsverlauf

Eingereicht: 21. Juni 2024

Angenommen: 20. August 2024

Artikel online veröffentlicht:
12. November 2024

• References

• 1 Longnecker DS, Thompson ED. In: The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery. 4th ed. Hoboken, NJ: John Wiley & Sons; 2023
• 2 Talathi SS, Zimmerman R, Young M. Anatomy, abdomen and pelvis, pancreas. StatPearls. Treasure Island, FL: StatPearls Publishing; 2024
• 3 Cheng CL, Sherman S, Watkins JL. et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006; 101 (01) 139-147
• 4 Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018; 27 (01) 149-154
• 5 Sutton VR, Hong MKY, Thomas PR. Using the 4-hour post-ERCP amylase level to predict post-ERCP pancreatitis. JOP 2011; 12 (04) 372-376
• 6 Choudhary A, Bechtold ML, Arif M. et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc 2011; 73 (02) 275-282
• 7 Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 2010; 42 (10) 842-853
• 8 Afghani E, Akshintala VS, Khashab MA. et al. 5-Fr vs. 3-Fr pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients: a systematic review and network meta-analysis. Endoscopy 2014; 46 (07) 573-580
• 9 Deviere J. Pancreatic stents. Gastrointest Endosc Clin N Am 2011; 21 (03) 499-510 , ix
• 10 Delhaye M, Matos C, Arvanitakis M, Deviere J. Pancreatic ductal system obstruction and acute recurrent pancreatitis. World J Gastroenterol 2008; 14 (07) 1027-1033
• 11 Drewes AM, Bouwense SAW, Campbell CM. et al; Working Group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17 (05) 720-731
• 12 Seicean A, Vultur S. Endoscopic therapy in chronic pancreatitis: current perspectives. Clin Exp Gastroenterol 2014; 8: 1-11
• 13 Mathieson JR, Cooperberg PL, Murray DJ, Dashefsky S, Christensen R, Schmidt N. Pancreatic duct obstruction treated with percutaneous antegrade insertion of a metal stent: report of two cases. Radiology 1992; 185 (02) 465-467
• 14 Ozturk M, Moore K, Kleedehn M, Ozkan O, Woods M. Percutaneous pancreatic duct stent placement for treatment of transplant pancreatic duct stricture: report of a case. J Vasc Interv Radiol 2020; 31 (11) 1934-1937
• 15 Ross AS, Kozarek RA. Therapeutic pancreatic endoscopy. Dig Liver Dis 2010; 42 (11) 749-756
• 16 Chandrasekhara V, Chathadi KV, Acosta RD. et al; ASGE Standards of Practice Committee. The role of endoscopy in benign pancreatic disease. Gastrointest Endosc 2015; 82 (02) 203-214
• 17 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline - updated august 2018. Endoscopy 2019; 51 (02) 179-193
• 18 Chathadi KV, Chandrasekhara V, Acosta RD. et al; ASGE Standards of Practice Committee. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc 2015; 81 (04) 795-803
• 19 Eleftherladis N, Dinu F, Delhaye M. et al. Long-term outcome after pancreatic stenting in severe chronic pancreatitis. Endoscopy 2005; 37 (03) 223-230
• 20 Tringali A, Bove V, Vadalà di Prampero SF. et al. Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy 2019; 51 (10) 930-935
• 21 Korpela T, Udd M, Lindström O, Kylänpää L. Fully covered self-expanding metal stents for benign refractory pancreatic duct strictures in chronic pancreatitis. Scand J Gastroenterol 2019; 54 (03) 365-370
• 22 Sofi AA, Khan MA, Ahmad S. et al. Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis. Pancreatology 2021; 21 (05) 854-861
• 23 Cahen DL, van der Merwe SW, Laleman W, Poley JW, Bruno MJ. A biodegradable non-covered self-expandable stent to treat pancreatic duct strictures in chronic pancreatitis: a proof of principle. Gastrointest Endosc 2018; 87 (02) 486-491
• 24 Conrad CC, Ellrichmann M. Stent placement in pancreatic disease, when, which and why? – a current perspective. Front Gastroenterol
• 25 Umapathy C, Gajendran M, Mann R. et al. Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management. Dis Mon 2020; 66 (11) 100986
• 26 Larsen M, Kozarek R. Management of pancreatic ductal leaks and fistulae. J Gastroenterol Hepatol 2014; 29 (07) 1360-1370
• 27 Liao Z, Gao R, Wang W. et al. A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy 2009; 41 (05) 439-444
• 28 Coleman SD, Eisen GM, Troughton AB, Cotton PB. Endoscopic treatment in pancreas divisum. Am J Gastroenterol 1994; 89 (08) 1152-1155
• 29 Michailidis L, Aslam B, Grigorian A, Mardini H. The efficacy of endoscopic therapy for pancreas divisum: a meta-analysis. Ann Gastroenterol 2017; 30 (05) 550-558
• 30 Ogura T, Ohama H, Higuchi K. Endoscopic ultrasound-guided pancreatic transmural stenting and transmural intervention. Clin Endosc 2020; 53 (04) 429-435
• 31 Stevens KJ, Lisanti C. Pancreas Imaging. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024
• 32 Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging 2012; 3 (01) 11-21
• 33 Testoni PA. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases. World J Gastroenterol 2007; 13 (45) 5971-5978
• 34 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 (05) 990-1000
• 35 Buscaglia JM, Kalloo AN. Pancreatic sphincterotomy: technique, indications, and complications. World J Gastroenterol 2007; 13 (30) 4064-4071
• 36 Mangiavillano B, Pagano N, Baron TH. et al. Biliary and pancreatic stenting: devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World J Gastrointest Endosc 2016; 8 (03) 143-156
• 37 Tonolini M, Bareggi E, Gambitta P. Advanced endoscopic interventions on the pancreas and pancreatic ductal system: a primer for radiologists. Insights Imaging 2019; 10 (01) 5
• 38 Cope C, Tuite C, Burke DR, Long WB. Percutaneous management of chronic pancreatic duct strictures and external fistulas with long-term results. J Vasc Interv Radiol 2001; 12 (01) 104-110
• 39 Siddiqui UD, Hawes RH. Chronic pancreatitis. Clin Gastrointest Endosc Elsevier 2019; 3: 686-698
• 40 Nagai K, Sofuni A, Tsuchiya T. et al. The feasibility of pancreatic duct stenting using a novel 4-Fr plastic stent with a 0.025-in. guidewire. Sci Rep 2021; 11 (01) 14285
• 41 Pal P, Ramchandani M. Management of ERCP complications. Best Pract Res Clin Gastroenterol 2024; 69 (101897): 101897
• 42 Sung H, Ferlay J, Siegel RL. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
• 43 Smith MT, Sherman S, Ikenberry SO, Hawes RH, Lehman GA. Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc 1996; 44 (03) 268-275
• 44 Kawaguchi Y, Lin JC, Kawashima Y. et al. Risk factors for migration, fracture, and dislocation of pancreatic stents. Gastroenterol Res Pract 2015; 2015: 365457
• 45 Bhandari S, Sharma A, Bathini R, Maydeo A. Endoscopic management of internally migrated pancreatic duct stents (with video). Indian J Gastroenterol 2016; 35 (02) 91-100