Abstract | BACKGROUND AND AIMS: METHODS: Patients with CP and symptomatic MPD stricture located in the head of the pancreas persisting for 3 months or more after placement of a single plastic stent were enrolled in a prospective single-arm trial. A nitinol FC-SEMS was inserted and removed after 6 months. The FC-SEMS diameter and length were chosen according to the stricture anatomy and MPD diameter above the stricture. Our primary objective was FC-SEMS removability. Secondary outcomes were MPD stricture resolution rate and adverse events. RESULTS: Between December 2012 and October 2014, 15 patients (10 male, mean age 60 years) were enrolled. Pancreatic calcifications were present in 6 (40%) patients. Four patients (27%) had a history of alcohol abuse. In 10 patients, the FC-SEMS was inserted through the major papilla, whereas 5 patients (3 pancreas divisum, 2 dominant dorsal duct) received the stent through the minor papilla. One patient developed cholangitis after 24 hours due to occlusion of the biliary sphincterotomy from the FC-SEMS; cholangitis resolved after insertion of a plastic biliary stent. Complete distal migration of the FC-SEMS was reported in 7 patients (47%) (5 asymptomatic, 2 symptomatic with recurrence of pancreatitis). All migrations occurred with the 3-cm-long FC-SEMS. Four patients (27%) developed de novo stricture induced by the FC-SEMS at the level of the flared end and were excluded from the follow-up; 1 patient with FC-SEMS migration had failed stricture resolution. One patient was lost to follow-up. Finally, 9 patients with MPD stricture resolution had a mean follow-up of 38.9 months (range, 5.3-55.3 months), and 89% were asymptomatic. CONCLUSIONS: FC-SEMS removability from the MPD in CP was feasible in all cases, and 90% of the patients were asymptomatic after 3 years. Migration seems more frequent with the 3-cm-long FC-SEMS. Occurrence of FC-SEMS-induced pancreatic strictures is a major issue and deserves further assessment. According to our experience, pancreatic FC-SEMSs have promising results, but a careful evaluation in the setting of clinical trials is needed.
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Authors | Andrea Tringali, Salvatore Francesco Vadalà di Prampero, Rosario Landi, Vincenzo Bove, Pietro Familiari, Jun Hamanaka, Fabia Attili, Guido Costamagna |
Journal | Gastrointestinal endoscopy
(Gastrointest Endosc)
Vol. 88
Issue 6
Pg. 939-946
(12 2018)
ISSN: 1097-6779 [Electronic] United States |
PMID | 30142349
(Publication Type: Journal Article)
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Copyright | Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Aged, 80 and over
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis
(etiology)
- Constriction, Pathologic
(etiology, therapy)
- Device Removal
- Dilatation
(adverse effects)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Pancreatic Ducts
(pathology)
- Pancreatitis, Chronic
(complications)
- Prospective Studies
- Prosthesis Failure
(adverse effects)
- Self Expandable Metallic Stents
(adverse effects)
- Time Factors
- Treatment Outcome
- Young Adult
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