We describe here our experience of successful closure of a lesion of the main pancreatic
duct by means of a constructed S-type pancreatic stent.
A 67-year-old woman with an abnormal biliary-pancreatic junction and a tumor of the
gallbladder underwent cholecystectomy plus R2, extrahepatic cholangiectomy, hepatocholangiojejunostomy,
and Roux-en-Y reconstruction on 2 February 2001. In the postoperative period pancreatic
fistulization occurred, with endoscopic retrograde cholangiopancreatography (ERCP)
revealing a leak of contrast medium medially to the common bile duct. A pancreatic
stent (GEPD, 7-Fr; Wilson-Cook, Winston-Salem, North Carolina, USA) was therefore
put in place. Unfortunately, the stent migrated 2 days later, and so it was replaced
with a constructed pancreatic stent with a shape which approximated to that of the
main pancreatic duct (Figure [1
Figure 1 A constructed 7-Fr stent (Olympus) with a shape approximating that of the main pancreatic
duct. See text for further description.
In our department, we have been using straight biliary stents (PBD, Olympus; or GEPD,
Wilson-Cook). However, as the main pancreatic duct has characteristic bends within
the pancreatic head, we were not able to stabilize the fixation of stents and consequently
they migrated. Because of this, in 1998 we constructed a stent with a shape which
approximated to that of the main pancreatic duct. The tip of the stent tapers and
sideholes have been added. The two bends in the stent correspond to the shape of the
main pancreatic duct. The material used is a polyolefin-based elastomer, with a flexibility
which is 50 - 70 % greater than that of PBD; this is important for the adaptation
of the stent to interindividual variability in the shape of the main pancreatic duct
(Figure [2 1 2 3
Figure 2 PBD (upper) and constructed (lower) stent material.
