Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(09): E1311-E1321
DOI: 10.1055/a-1880-7430
Review

Covered self-expandable metal stents for pancreatic duct stricture: a systematic review and meta-analysis

Alberto Tringali
1   Endoscopy Unit, Department of Medicine, ULSS 2 Marca Trevigiana, Conegliano Hospital, Italy
,
Deborah Costa
1   Endoscopy Unit, Department of Medicine, ULSS 2 Marca Trevigiana, Conegliano Hospital, Italy
,
Matteo Rota
2   Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
,
Douglas G. Adler
3   Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Denver, Colorado, United States
,
Guido Costamagna
4   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Placement of a covered (C)-self-expandable metal stent (SEMS) has been recently investigated as an alternative endoscopic treatment for main pancreatic duct stricture (MPDS) in chronic pancreatitis. Our aim was to carry out a systematic review and meta-analysis of studies quantifying efficacy and safety of C-SEMSs in the management of MPDS.

Methods A multiple database search was performed, including MEDLINE, Embase and Cochrane Library, from January 2000 to September 2020, to identify studies reporting the efficacy and safety of C-SEMSs in patients with MPDS. Stricture and pain resolution were investigated. Other outcomes included technical success, stent migration, stricture recurrence and need for repeated stent placement. Pancreatitis, severe abdominal pain requiring stent removal and de-novo stricture were recorded as complications.

Results Nineteen studies were identified, which included a total of 300 patients. C-SEMSs showed a pooled stricture resolution rate of 91 % [95 % confidence interval (CI), 85 %–96 %] and a pooled pain resolution rate of 92 % (95 % CI, 85 %–98 %). The pooled proportion for stricture recurrence was equal to 6 % (95 % CI, 1 %–14 %), while stent migration occurred in 33 of 300 patients, the pooled proportion being 7 % (95 % CI 1 %–15 %). The pooled mean stent duration was 133 days (95 % CI, 100–166 days). The most common complication was pancreatitis (3 %, 95 % CI 0 %–8 %), while de-novo stricture pooled proportion was 2 % (95 % CI, 0 %–5 %).

Conclusions C-SEMSs are effective and safe in the treatment of MPDS. However, there is a significant need for further high-quality, well-designed studies to produce evidence-based data on short and long-term efficacy, safety, costs of C-SEMSs, and also optimal stent duration.

Supplementary material



Publication History

Received: 05 December 2021

Accepted after revision: 14 June 2022

Accepted Manuscript online:
21 June 2022

Article published online:
14 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lohr JM, Dominguez-Munoz E, Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). UNITED Eur Gastroenterol J 2017; 5: 153-199
    CrossrefPubMedGoogle Scholar
  • 2 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: 179-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Cahen DL, Gouma DJ, Nio Y. et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356: 676-684
    CrossrefPubMedGoogle Scholar
  • 4 Ponchon T, Bory RM, Hedelius F. et al. Endoscopic stenting for pain relief in chronic pancreatitis: Results of a standardized protocol. Gastrointest Endosc 1995; 42: 452-456
    CrossrefPubMedGoogle Scholar
  • 5 Cremer M, Devière J, Delhaye M. et al. Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy 1991; 23: 171-176
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Ishihara T, Yamaguchi T, Seza K. et al. Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis. Scand J Gastroenterol 2006; 41: 744-750
    CrossrefPubMedGoogle Scholar
  • 7 Topazian M, Aslanian H, Andersen D. Outcome following endoscopic stenting of pancreatic duct strictures in chronic pancreatitis. J Clin Gastroenterol 2005; 39: 908-911
    CrossrefPubMedGoogle Scholar
  • 8 Jafri M, Sachdev A, Sadiq J. et al. Efficacy of endotherapy in the treatment of pain associated with chronic pancreatitis: a systematic review and meta-analysis. J Pancreas 2017; 18: 125-132
    PubMedGoogle Scholar
  • 9 Costamagna G, Bulajic M, Tringali A. et al. Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results. Endoscopy 2006; 38: 254-259
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 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: 930-935
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Seza K, Yamaguchi T, Ishihara T. et al. A long-term controlled trial of endoscopic pancreatic stenting for treatment of main pancreatic duct stricture in chronic pancreatitis. Hepatogastroenterology 2011; 58: 2128-2131
    PubMedGoogle Scholar
  • 12 Shen Y, Liu M, Chen M. et al. Covered metal stent or multiple plastic stents for refractory pancreatic ductal strictures in chronic pancreatitis: A systematic review. Pancreatology 2014; 14: 87-90
    CrossrefPubMedGoogle Scholar
  • 13 Li TT, Song SL, Xiao LN. et al. Efficacy of fully covered self-expandable metal stents for the management of pancreatic duct strictures in chronic pancreatitis: A systematic review and meta-analysis. J Gastroenterol Hepatol 2020; 35: 1099-1106
    CrossrefPubMedGoogle Scholar
  • 14 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
    Google Scholar
  • 15 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    Google Scholar
  • 16 Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    Google Scholar
  • 17 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    Google Scholar
  • 18 Cho JH, Kim EJ, Kim KO. et al. Long-term outcomes of fully covered self-expandable metal stents in benign pancreatic ductal stricture of chronic pancreatitis. Pancreas 2019; 48: 1414
    PubMedGoogle Scholar
  • 19 Patel A, Ukabam OC, Atluri S. et al. The use of fully covered metal stents in the management of benign refractory pancreatic ductal strictures. Gastrointest Endosc 2017; 85: AB236
    CrossrefPubMedGoogle Scholar
  • 20 Jain RP, Dharamsi S, Basava G. et al. Long term outcomes of fully covered self-expanding metal stents for refractory pancreatic duct strictures due to chronic pancreatitis-a single center experience from India. J Gastroenterol Hepatol 2019; 34: 218
    PubMedGoogle Scholar
  • 21 Sangwaiya A, Butt MA, Rajaratnam R. et al. Covered metal stent placement using Santorini’s duct (minor papilla) for pain management in chronic calcific pancreatitis – feasibility and safety. Gastrointest Endosc 2015; 81: AB404
    CrossrefPubMedGoogle Scholar
  • 22 Shen Y-H, Li Y-H, Wang L. et al. Placement of a fully covered self-expandable metal stent for refractory chronic pancreatitis: A preliminary study. J Dig Dis 2019; 20: 5
    PubMedGoogle Scholar
  • 23 Traini M, Mariani A, Petrone MC. et al. Fully covered self-expandable metal stents (FC-SEMS) in the treatment of main pancreatic duct (MPD) strictures due to chronic pancreatitis (CP): A case series. Dig Liver Dis 2018; 50: e146
    CrossrefPubMedGoogle Scholar
  • 24 Giacino C, Grandval P, Laugier R. Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy 2012; 44: 874-877
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Sauer B, Talreja J, Ellen K. et al. Temporary placement of a fully covered self-expandable metal stent in the pancreatic duct for management of symptomatic refractory chronic pancreatitis: preliminary data (with videos). Gastrointest Endosc 2008; 68: 1173-1178
    CrossrefPubMedGoogle Scholar
  • 26 Park DH, Kim MH, Moon SH. et al. Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic ductal strictures: a pilot study (with video). Gastrointest Endosc 2008; 68: 1182-1189
    CrossrefPubMedGoogle Scholar
  • 27 Moon S-H, Kim M-H, Park DH. et al. Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc 2010; 72: 86-91
    CrossrefPubMedGoogle Scholar
  • 28 Tringali A, Vadalà di Prampero SF, Landi R. et al. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc 2018; 88: 939-946
    CrossrefPubMedGoogle Scholar
  • 29 Sharaiha RZ, Novikov A, Weaver K. et al. Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience. Endosc Int Open 2019; 7: E1419-E1423
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Korpela T, Udd M, Lindström O. et al. Fully covered self-expanding metal stents for benign refractory pancreatic duct strictures in chronic pancreatitis. Scand J Gastroenterol 2019; 54: 365-370
    CrossrefPubMedGoogle Scholar
  • 31 Lee YN, Moon JH, Park JK. et al. Preliminary study of a modified, nonflared, short, fully covered metal stent for refractory benign pancreatic duct strictures (with videos). Gastrointest Endosc 2020; 91: 826-833
    CrossrefPubMedGoogle Scholar
  • 32 Ogura T, Onda S, Takagi W. et al. Placement of a 6 mm, fully covered metal stent for main pancreatic head duct stricture due to chronic pancreatitis: A pilot study (with video). Therap Adv Gastroenterol 2016; 9: 722-728
    CrossrefPubMedGoogle Scholar
  • 33 Yamada T, Ogura T, Okuda A. et al. Pilot Study of Dumbbell-Type Covered Self-Expandable Metal Stent Deployment for Benign Pancreatic Duct Stricture (with Videos). J Gastrointest Surg 2018; 22: 2194-2200
    CrossrefPubMedGoogle Scholar
  • 34 Oh D, Lee JH, Song TJ. et al. Long-term outcomes of 6-mm diameter fully covered self-expandable metal stents in benign refractory pancreatic ductal stricture. Dig Endosc 2018; 30: 508-515
    CrossrefPubMedGoogle Scholar
  • 35 Okushima K, Yoshino J, Inui K. et al. Short-term metal stenting for treatment of main pancreatic duct strictures associated with chronic pancreatitis. Dig Endosc 2005; 17: 230-234
    CrossrefPubMedGoogle Scholar
  • 36 Matsubara S, Sasahira N, Isayama H. et al. Prospective pilot study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: long-term outcomes. Endosc Int Open 2016; 04: E1227-E1227
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Tammaro S, Caruso R, Pallone F. et al. Post-endoscopic retrograde cholangio-pancreatography pancreatitis: is time for a new preventive approach?. World J Gastroenterol 2012; 18: 4635-4638
    CrossrefPubMedGoogle Scholar
  • 38 Puig I, Calvet X, Baylina M. et al. How and when should NSAIDs be used for preventing post-ERCP pancreatitis?. A systematic review and meta-analysis. PLoS One 2014; 9: e92922
    CrossrefPubMedGoogle Scholar
  • 39 Wong L-L, Tsai H-H. Prevention of post-ERCP pancreatitis. World J Gastrointest Pathophysiol 2014; 5: 1-10
    CrossrefPubMedGoogle Scholar
  • 40 Haapamäki C, Kylänpää L, Udd M. et al. Randomized multicenter study of multiple plastic stents vscovered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis. Endoscopy 2015; 47: 605-610
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Cahen DL, van der Merwe SW, Laleman W. et al. A biodegradable non-covered self-expandable stent to treat pancreatic duct strictures in chronic pancreatitis: a proof of principle. Gastrointest Endosc 2018; 87: 486-491
    CrossrefPubMedGoogle Scholar