Elsevier

Gastrointestinal Endoscopy

Volume 44, Issue 3, September 1996, Pages 276-282
Gastrointestinal Endoscopy

Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP,☆☆,

Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 1995, San Diego, California, (Gastrointest Endosc 1995;41:429).
https://doi.org/10.1016/S0016-5107(96)70164-5Get rights and content

Abstract

Background: Polyethylene pancreatic duct stents induce morphologic changes of the pancreatic duct in the majority of patients. This study was undertaken to determine if parenchymal abnormalities are present in patients undergoing short-term pancreatic duct stenting and to correlate these findings with the pancreatogram obtained at stent removal.

Methods: Twenty-five patients underwent pancreatic duct stenting and had an endoscopic ultrasound evaluation of the pancreas at stent removal. The pancreatograms were evaluated at stent removal for ductal irregularity, narrowing, and side branch changes. Endoscopic ultrasound was used to assess for differences in the echo characteristics of the pancreatic parenchyma around the stent compared with the rest of the gland.

Results: Of the 16 patients evaluated by ERCP at stent removal, 9 (56%) had 1 or more new ductographic changes. Endoscopic ultrasound identified parenchymal changes in the stented region in 17 of 25 patients (68%). Four patients who had parenchymal changes in the stented region on endoscopic ultrasound at stent removal had a follow-up study at a mean time of 16 months. Two patients had (new) changes suggestive of focal chronic pancreatitis in the stented region.

Conclusion: Short-term pancreatic duct stenting induced both ductal and parenchymal changes in more than 50% of patients. Chronic pancreatitis may be a consequence of pancreatic duct stenting. (Gastrointest Endosc 1996;44:276-82.)

Section snippets

MATERIALS AND METHODS

The subjects of this study were 25 patients who underwent short-term pancreatic duct stenting (mean time, 22 days; range, 8 to 60 days) and had an endoscopic ultrasound (EUS) evaluation of the pancreas at the time of stent removal (Table 1). The pancreatic stents were placed for guiding a pancreatic sphincterotomy (n = 9); treatment of pancreas divisum (n = 6); guiding a pre-cut biliary endoscopic sphincterotomy (n = 6); pancreatic protection following standard biliary endoscopic sphincterotomy

RESULTS

Twenty-one patients had a normal baseline pancreatogram, whereas 4 had changes of mild chronic pancreatitis (Table 1). Of the 16 evaluated by ERCP at stent removal, 9 (56.3%) had one or more new ductographic changes (Fig. 1, Fig. 2; Table 2).

. A, Normal dorsal pancreatogram in a patient (patient #22) with pancreas divisum. B, 6F, 4 cm pancreatic stent placed into dorsal duct. C, Dorsal pancreatogram at stent removal (day 56) shows ductal irregularity with severe narrowing (arrowhead) in the

DISCUSSION

Polyethylene pancreatic duct stents are being utilized for the treatment of a variety of benign pancreatic disorders.12 Although therapeutic benefit has been reported for pancreatic stenting, it has been evident that morphologic changes of the pancreatic duct directly related to this therapy occur in the majority of patients. In summarizing the results of seven published series, new ductal changes were seen in 54% of 297 patients stented (Table 4). Preliminary data suggested that these

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

☆☆

Reprint requests: Stuart Sherman, MD, Gastroenterology, Indiana University Hospital, 550 North University Blvd., Suite 2300, Indianapolis, IN 46202-5000.

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