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DOI: 10.1055/s-2007-966815
© Georg Thieme Verlag KG Stuttgart · New York
Small prophylactic pancreatic duct stents: an assessment of spontaneous passage and stent-induced ductal abnormalities
Publikationsverlauf
submitted 24 January 2007
accepted after revision 4 July 2007
Publikationsdatum:
21. September 2007 (online)
Background and study aims: Placing small stents in the pancreatic duct at endoscopic retrograde cholangiopancreatography reduces the risk of pancreatitis. However, this practice means that a second procedure might be required to remove the stent, and stents can also damage the duct. The aims of this study were to determine the frequency of spontaneous dislodgment and to assess the incidence of stent-induced ductal irregularities.
Patients and methods: We performed a retrospective analysis of consecutive patients seen over a 3-year period (2001 - 2004) who had undergone placement of a 3-Fr pancreatic duct stent and in whom the fate of the stent had been documented. Radiographs were reviewed to determine stent passage at 30 days. If applicable, follow-up pancreatograms were reviewed to assess for stent-induced ductal abnormalities. Statistical analysis was performed using chi-squared and Fisher’s exact tests for proportions, and 95 % binomial confidence intervals (CI) were calculated.
Results: Records for 125 consecutive patients who had had 3-Fr pancreatic stents placed were reviewed. The stents had passed spontaneously within 30 days in 110/125 patients (88 %). In the remaining 15 patients (12 %, 95 % CI 6.9 % - 19 %), the stents were still present on follow-up radiographs after a median time of 36 days, (range 31 - 116 days). Stent length, pancreatic sphincterotomy, and pancreas divisum had no effect on the likelihood of spontaneous passage. No stent-induced ductal irregularities were observed.
Conclusions: Nearly 90 % of prophylactic 3-Fr pancreatic duct stents pass spontaneously within 30 days, and these stents were not observed to induce changes in the pancreatic duct.
References
- 1 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996; 335 909-918
- 2 Fazel A, Quadri A, Catalano M F. et al . Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003; 57 291-294
- 3 Tarnasky P R, Palesch Y Y, Cunningham J T. et al . Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998; 115 1518-1524
- 4 Fogel E L, Eversman D, Jamidar P. et al . Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002; 34 280-285
- 5 Singh P, Das A, Isenberg G. et al . Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004; 60 544-550
- 6 Sherman S, Alvarez C, Robert M. et al . Polyethylene pancreatic duct stent-induced changes in the normal dog pancreas. Gastrointest Endosc. 1993; 39 658-664
- 7 Kozarek R A. Pancreatic stents can induce ductal changes consistent with chronic pancreatitis. Gastrointest Endosc. 1990; 36 93-95
- 8 Rashdan A, Fogel E L, McHenry Jr L. et al . Improved stent characteristics for prophylaxis of post-ERCP pancreatitis. Clin Gastroenterol Hepatol. 2004; 2 322-329
- 9 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 10 Corazziari E, Shaffer E A, Hogan W J. et al . Functional disorders of the biliary tract and pancreas. Gut. 1999; 45 (Suppl 2) II48-II54
- 11 Hogan W J, Geenen J E. Biliary dyskinesia. Endoscopy. 1988; 20 (Suppl 1) 179-183
- 12 Axon A T, Classen M, Cotton P B. et al . Pancreatography in chronic pancreatitis: international definitions. Gut. 1984; 25 1107-1112
- 13 Freeman M L, Guda N M. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc. 2004; 59 845-864
- 14 Freeman M L. Role of pancreatic stents in prevention of post-ERCP pancreatitis. JOP. 2004; 5 322-327
- 15 Freeman M L, Overby C, Qi D. Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success. Gastrointest Endosc. 2004; 59 8-14
- 16 Smithline A, Silverman W, Rogers D. et al . Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients. Gastrointest Endosc. 1993; 39 652-657
- 17 Smith M T, Sherman S, Ikenberry S O. et al . Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc. 1996; 44 268-275
- 18 Sherman S, Hawes R H, Savides T J. et al . Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP. Gastrointest Endosc. 1996; 44 276-282
- 19 Siegel J, Veerappan A. Endoscopic management of pancreatic disorders: potential risks of pancreatic prostheses. Endoscopy. 1991; 23 177-180
- 20 Alvarez C, Robert M, Sherman S, Reber H A. Histologic changes after stenting of the pancreatic duct. Arch Surg. 1994; 129 765-768
C. Lawrence, MD
Digestive Disease Center
Medical University of South Carolina
96 Jonathan Lucas Street, Suite 210
POB 250327
Charleston
South Carolina 29425
USA
Fax: +1-843-792-1707
eMail: Lawrench@musc.edu