Elsevier

Gastrointestinal Endoscopy

Volume 44, Issue 3, September 1996, Pages 268-275
Gastrointestinal Endoscopy

Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy,☆☆,,★★,

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 1993, Boston, Massachusetts, (Gastrointest Endosc 1993;39:332).
https://doi.org/10.1016/S0016-5107(96)70163-3Get rights and content

Abstract

Background: Polyethylene stents placed in the main pancreatic duct induce morphologic alterations that may resemble chronic pancreatitis.

Methods: We reviewed the sequential pancreatograms of stented patients who had long-term follow-up after stent removal.

Results: Forty patients (66%) had a normal baseline pancreatogram, whereas 21 (34%) showed changes of chronic pancreatitis. In 49 of 61 patients (80.3%), one or more had new morphologic changes immediately after stent withdrawal graded as mild (69%), moderate (29%), or severe (2%). Changes included ductal irregularity (49%), narrowing (35.5%), and side branch change(15.5%). Sixteen of the 21 patients (76.1%) with an abnormal baseline pancreatogram had worsening of the baseline abnormality or additional changes while stented, whereas 33 of 40 (82.5%) with a normal baseline developed new morphologic changes. Correlation of stent-induced changes with stent size, length, patency at removal, and duration of stenting failed to show an association. Twenty-five patients with stent-induced changes had a follow-up pancreatogram at a mean of 192 days (10 to 740) after stent removal. There was complete resolution of the changes in 64%, partial resolution in 32%, and no improvement in 5%.

Conclusion: Morphologic changes induced by polyethylene pancreatic duct stents occurred in 80% of patients. More than one third of these changes did not resolve during the follow-up period. Because of concern over stent-induced fibrosis, the use of pancreatic stents should remain largely experimental. (Gastrointest Endosc 1996;44:268-75.)

Section snippets

MATERIALS and METHODS

We reviewed the sequential pancreatograms of patients who had undergone pancreatic stenting at baseline (prior to stenting), immediately after stent removal, and after a remote interval when a follow-up study had been performed for clinical indications. All ductographic abnormalities were recorded with emphasis on their location, type of change, and severity. Baseline pancreatograms were read according to Cambridge criteria10 and classified as normal or abnormal (equivocal changes were

Frequency, type, and location of stent-induced ductal changes

Of the 61 patients studied, 40 (65.6%) had a normal baseline prestenting pancreatogram and 21 (34.4%) had changes of chronic pancreatitis. Most patients with normal baseline pancreatograms had stents inserted either for therapy of pancreas divisum or prior to pre-cut biliary sphincterotomy.13 Forty-nine patients (80.3%) were found to have stent-induced changes at the time of stent removal (Table 1). Twelve (19.7%) had no changes from the baseline pancreatogram. Of the total stent-induced

DISCUSSION

The use of endoscopic therapy for pancreatic diseases has progressed at a slower pace than similar techniques in the biliary tree, primarily because of the concern for procedure-related complications.14 Controlled trials regarding the efficacy and safety of pancreatic duct stenting are limited, and at this point firm indications for endoscopic drainage of the pancreas have not been established.15 Pancreatic stents may be beneficial to facilitate drainage in patients whose symptoms are believed

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  • Cited by (0)

    From the Indiana University Medical Center, Division of Gastroenterology/Hepatology, Indianapolis, Indiana.

    ☆☆

    Current address for Dr. Smith: Walter Reed Army Medical Center, Washington, D.C. Current address for Dr. Hawes: Medical University of South Carolina, Charleston, S.C.

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

    ★★

    Reprint requests: Glen A. Lehman, MD, Indiana University Medical Center, 550 North University Blvd., Suite 2300, Indianapolis, IN 46202.

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