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)

Sauer, Bryan; Talreja, Jayant; Ellen, Kristi; Ku, Jennifer; Shami, Vanessa M.; Kahaleh, Michel

doi:10.1016/j.gie.2008.06.011

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Volume 68, Issue 6 , Pages 1173-1178, December 2008

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)

Current affiliations: Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia, USA

Received 29 January 2008; accepted 9 June 2008.

Charlottesville, Virginia, USA

Background

Pancreatic duct (PD) stenting is beneficial for the treatment of pain in patients with PD strictures associated with chronic pancreatitis. Placement of metal stents has been reported but failed secondary to hyperplasia or migration.

Objective

To investigate the outcome of patients with symptomatic and refractory PD strictures who had temporary placement of a covered self-expandable metal stent (CSEMS).

Design

Patients with refractory PD strictures were offered temporary CSEMS placement. Pain scores were evaluated before and after CSEMS placement.

Setting

A tertiary-care center.

Patients

Six patients (4 men, mean age ± SD 55 ± 8 years) received a CSEMS, and 5 patients had removal of a CSEMS after a mean time of 92 days.

Intervention

Placement of CSEMS (8-mm or 10-mm diameter VIABIL) in the PD, with removal after 3 months.

Main Outcome Measurements

The pain score before and after stent placement and the sustained response after removal. Morbidity associated with stent placement and removal was also noted.

Results

Pain scores after CSEMS placement significantly improved (P = .024), from 6.4 to 1.6. Of the 5 patients who underwent CSEMS removal, 3 developed recurrent symptomatic pancreatic stricture, of whom 2 required repeat stenting with a larger-diameter CSEMS (10 mm) and 2 remained pain free. The CSEMS was not removed in 1 patient because pancreatic malignancy was diagnosed. There were no complications during placement or removal of CSEMSs.

Limitation

This was a pilot study.

Conclusion

Temporary placement of CSEMSs in patients with symptomatic refractory PD stricture offers transient relief of pain. Further investigation is needed to determine the optimal diameter and duration of placement.

Abbreviations: CSEMS, fully covered self-expanding metal stent, PD, pancreatic duct, SEMS, self-expanding metal stent, VAS, visual analog scale