Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis

Andrea Tringali; Vincenzo Bove; Salvatore F. Vadalà di Prampero; Ivo Boškoski; Pietro Familiari; Vincenzo Perri; Guido Costamagna

doi:10.1055/a-0959-6163

Endoscopy, Table of Contents

Endoscopy 2019; 51(10): 930-935
DOI: 10.1055/a-0959-6163

Original article

Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis

Andrea Tringali

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

,

Vincenzo Bove

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

,

Salvatore F. Vadalà di Prampero

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

³Department of Gastroenterology and GI Endoscopy, University Hospital of Udine, Udine, Italy

,

Ivo Boškoski

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

,

Pietro Familiari

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

,

Vincenzo Perri

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

,

Guido Costamagna

¹Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

²Centre for Endoscopic Research Therapeutics and Training – CERTT, Università Cattolica del Sacro Cuore, Rome, Italy

› Author Affiliations

Abstract

Background Dominant pancreatic duct strictures in chronic pancreatitis are often managed by endoscopic placement of a single plastic stent. Insertion of multiple plastic stents (MPS) has been proven to be effective in managing refractory strictures, but data are still limited. The aim of this study was to investigate the efficacy and long-term results of MPS to dilate pancreatic duct strictures in chronic pancreatitis.

Methods 48 patients (34 men; mean age 44 years) with chronic pancreatitis and a single pancreatic stent through a refractory stricture in the pancreatic head underwent the following protocol: 1) removal of the single pancreatic stent; 2) balloon dilation of the stricture; 3) insertion of the maximum number of stents; 4) stent removal after 6 – 12 months.

Results The median number of pancreatic plastic stents placed was 3 (diameter 7 – 11.5 Fr, length 3 – 7 cm). Five patients (10.4 %) had persistent strictures after MPS removal. During a mean follow-up of 9.5 years (0.3 – 15.5 years) after stent removal, 74.4 % (32/43) of the patients were asymptomatic, and 25.6 % (11/43) experienced pancreatitis recurrence or pancreatic type pain after a mean time of 26.4 months (8/43, 18.6 % underwent plug extraction without evidence of stricture recurrence; 3/43, 7.0 % had stricture recurrence). No major complications were recorded.

Conclusion Endoscopic multiple plastic stenting of chronic pancreatitis-related pancreatic duct strictures showed satisfactory long-term results, with the option of re-treatment. This procedure can be considered an important therapeutic alternative for painful pancreatic duct strictures located in the head of the pancreas in the setting of chronic pancreatitis.

Full Text

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