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Complications of Pancreatic Stents

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Pancreatic plastic stents were introduced in the early 1980s for the management of pancreatic duct strictures in chronic pancreatitis. Since then, their use has steadily increased, leading to a higher reporting of adverse events. The most common complications are pain, pancreatitis, sepsis resulting in pancreatic abscesses, ductal stent induced strictures, and stent migration. Although plastic stents are still the mainstay in prevention of PEP and in the treatment of chronic pancreatitis, new metal and biodegradable stents have recently been developed with similar adverse events. Complications can be prevented by careful choice of the appropriate stent in the various indications and anatomies and regular follow-up of the patients. Management of complications implies removal of the stents with various devices (mainly rat tooth forceps, balloon extractors, and baskets), sometimes with the help of single-operator cholangiopancreatoscopes, repositioning of new stents in case of induced strictures, and drainage of collections. In this chapter, we will cover the respective incidence, management, and prevention of complications observed for each type of pancreatic stent.

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Abbreviations

BD-PS:

Biodegradable pancreatic stent

FC-SEMS:

Full covered Self-expandable metal stents

PS:

Plastic stent

SEMS:

Self-expandable metal stents

References

  1. Cremer M, Deviere J, Delhaye M et al (1991) Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy 23:171–176

    Article  CAS  Google Scholar 

  2. Johanson JF, Schmalz MJ, Geenen JE (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38:341–346

    Article  CAS  Google Scholar 

  3. Binmoeller KF, Jue P, Seifert H et al (1995) Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy 27:638–644

    Article  CAS  Google Scholar 

  4. Fuji T, Amano H, Harima K, et al. Pancreatic sphincterotomy and pancreatic endoprosthesis. Endoscopy. https://doi.org/10.1055/s-2007-1018460. Epub ahead of print 1985

  5. Ramesh H (1997) Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc 46:196–197

    Article  CAS  Google Scholar 

  6. Ponchon T, Bory RM, Hedelius F et al (1995) Endoscopic stenting for pain relief in chronic pancreatitis: Results of a standardized protocol. Gastrointest Endosc 42:452–456

    Article  CAS  Google Scholar 

  7. Smits ME, Badiga SM, Rauws EAJ et al (1995) Long-term results of pancreatic stents in chronic pancreatitis. Gastrointest Endosc 42:461–467

    Article  CAS  Google Scholar 

  8. Dumonceau J-M, Delhaye M, Tringali A et al (2019) Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – updated August 2018. Endoscopy 51:179–193

    Article  Google Scholar 

  9. Chen Y, Jiang Y, Qian W et al (2019) Endoscopic transpapillary drainage in disconnected pancreatic duct syndrome after acute pancreatitis and trauma: Long-term outcomes in 31 patients. BMC Gastroenterol 19(1):54

    Article  Google Scholar 

  10. Dumonceau JM, Kapral C, Aabakken L et al (2020) ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 52:127–149

    Article  Google Scholar 

  11. Provansal-Cheylan M, Bernard JP, Mariani A et al (1989) Occluded pancreatic endoprostheses – analysis of the clogging material. Endoscopy 21:63–69

    Article  CAS  Google Scholar 

  12. Johanson JF, Schmalz MJ, Geenen JE (1993) Simple modification of a pancreatic duct stent to prevent proximal migration. Gastrointest Endosc 39:62–64

    Article  CAS  Google Scholar 

  13. Eisendrath P, Deviere J (1999) Expandable metal stents for benign pancreatic duct obstruction. Gastrointest Endosc Clin N Am 9:547–554

    Article  CAS  Google Scholar 

  14. Moon SH, Kim MH, Park DH et al (2010) Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc 72:86–91

    Article  Google Scholar 

  15. Park DH, Kim MH, Moon SH et al (2008) Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic ductal strictures: a pilot study (with video). Gastrointest Endosc 68:1182–1189

    Article  Google Scholar 

  16. Laukkarinen J, Lämsä T, Nordback I et al (2008) A novel biodegradable pancreatic stent for human pancreatic applications: a preclinical safety study in a large animal model. Gastrointest Endosc 67:1106–1112

    Article  Google Scholar 

  17. Cahen DL, van der Merwe SW, Laleman W et al (2018) A biodegradable non-covered self-expandable stent to treat pancreatic duct strictures in chronic pancreatitis: a proof of principle. Gastrointest Endosc 87:486–491

    Article  Google Scholar 

  18. Anderloni A, Fugazza A, Maroni L et al (2020) New biliary and pancreatic biodegradable stent placement: a single-center, prospective, pilot study (with video). Gastrointest Endosc. https://doi.org/10.1016/j.gie.2020.02.049

  19. Chahal P, Tarnasky PR, Petersen BT et al (2009) Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol 7(8):834–839. https://doi.org/10.1016/j.cgh.2009.05.002. Epub 2009 May 15

    Article  PubMed  Google Scholar 

  20. Farnbacher MJ, Radespiel-Tröger M, König MD et al (2006) Pancreatic endoprostheses in chronic pancreatitis: criteria to predict stent occlusion. Gastrointest Endosc 63(1):60–66. https://doi.org/10.1016/j.gie.2005.08.046

    Article  PubMed  Google Scholar 

  21. Eleftheriadis N, Dinu F, Delhaye M et al (2005) Long-term outcome after pancreatic stenting in severe chronic pancreatitis. Endoscopy 37(3):223–230. https://doi.org/10.1055/s-2005-860988

    Article  Google Scholar 

  22. Weber A, Schneider J, Neu B et al (2013) Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol 19(5):715–720. https://doi.org/10.3748/wjg.v19.i5.715

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kawaguchi Y, Lin JC, Kawashima Y et al (2015) Risk factors for migration, fracture, and dislocation of pancreatic stents. Gastroenterol Res Pract 2015:365457. https://doi.org/10.1155/2015/365457. Epub 2015 Apr 5

    Article  PubMed  PubMed Central  Google Scholar 

  24. lei YX, song YL, Liu Q et al (2020) Risk factors for distal migration of biliary plastic stents and related duodenal injury. Surg Endosc 34(4):1722–1728. https://doi.org/10.1007/s00464-019-06957-x. Epub 2019 Jul 18

    Article  Google Scholar 

  25. Lahoti S, Catalano MF, Geenen JE et al (1998) Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center. Gastrointest Endosc 47(6):486–491. https://doi.org/10.1016/s0016-5107(98)70249-4

    Article  CAS  PubMed  Google Scholar 

  26. Gong B, Sun B, Hao LX et al (2011) Usefulness of an algorithm for endoscopic retrieval of proximally migrated 5Fr and 7Fr pancreatic stents. Hepatobiliary Pancreat Dis Int 10(2):196–200. https://doi.org/10.1016/s1499-3872(11)60031-3

    Article  PubMed  Google Scholar 

  27. Lu Y, Jin Z, Wu JC et al (2015) Endoscopic retrieval technique of proximally migrated pancreatic stents: a retrospective study in a tertiary centre. Gastroenterol Res Pract 2015:485980. https://doi.org/10.1155/2015/485980. Epub 2015 Mar 31

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yoon LA, Moon JH, Choi HJ, et al (2011) Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents after endoscopic papillectomy for ampullary adenoma. Gut Liver 5(4):532–535. https://doi.org/10.5009/gnl.2011.5.4.532. Epub 2011 Nov 21

  29. Rana SS, Sharma R, Gupta R (2020) Endoscopic retrieval of two proximally migrated plastic pancreatic duct stents. JGH Open 4:97–98

    Article  Google Scholar 

  30. Matsumoto K, Katanuma A, Maguchi H (2014) Endoscopic removal technique of migrated pancreatic plastic stents. J Hepatobiliary Pancreat Sci 21(6):E34–E40. https://doi.org/10.1002/jhbp.94. Epub 2014 Feb 17

    Article  PubMed  Google Scholar 

  31. Price LH, Brandabur JJ, Kozarek RA et al (2009) Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents. Gastrointest Endosc 70(1):174–179. https://doi.org/10.1016/j.gie.2008.12.051

    Article  PubMed  Google Scholar 

  32. Rastegari S, Craig C, John E et al (2020) Use of intraductal cholangioscopy devices to retrieve migrated pancreatic stents. Endoscopy 52(6):E202–E203. https://doi.org/10.1055/a-1066-4453. Epub 2019 Dec 13.3

    Article  PubMed  Google Scholar 

  33. Rahimi A, Ejtehadi F (2016) SpyGlass pancreatoscopy and successful retrieval of a proximally migrated pancreatic stent; unusual case and technical tips. Middle East J Dig Dis 8(3):232–234. https://doi.org/10.15171/mejdd.2016.26

    Article  PubMed  PubMed Central  Google Scholar 

  34. Maydeo A, Kwek A, Bhandari S et al (2011) SpyGlass pancreatoscopy-guided cannulation and retrieval of a deeply migrated pancreatic duct stent. Endoscopy 43(Suppl 2):UCTN:E137-8. https://doi.org/10.1055/s-0030-1256205. Epub 2011 Mar 18

    Article  PubMed  Google Scholar 

  35. Wu H, Wang L, Chen H et al (2020) Successful removal of a trapped pancreatic plastic stent using extracorporeal shock wave lithotripsy. Endoscopy 52:E86–E87

    Article  Google Scholar 

  36. Asif S, Kalpala R, Reddy DN. Peroral pancreatoscopy-assisted removal of internally migrated fractured pancreatic stent. Endoscopy. https://doi.org/10.1055/a-1122-8051. Epub ahead of print 27 March 2020.

  37. Li TT, Song SL, Xiao LN, et al Efficacy of fully covered self-expandable metal stents for the management of pancreatic duct strictures in chronic pancreatitis: a systematic review and meta-analysis. J Gastroenterol Hepatol (Australia). https://doi.org/10.1111/jgh.14972. Epub ahead of print 3 January 2020

  38. Oh D, Lee JH, Song TJ, et al (2018) Long-term outcomes of 6-mm diameter fully covered self-expandable metal stents in benign refractory pancreatic ductal stricture. Dig Endosc. https://doi.org/10.1111/den.13041. Epub ahead of print

  39. Giacino C, Grandval P, Laugier R (2012) Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy 44(9):874–877. https://doi.org/10.1055/s-0032-1309774. Epub 2012 Jul 23

    Article  CAS  PubMed  Google Scholar 

  40. Ogura T, Onda S, Takagi W et al (2016) Placement of a 6 mm, fully covered metal stent for main pancreatic head duct stricture due to chronic pancreatitis: A pilot study (with video). Therap Adv Gastroenterol 9(5):722–728. https://doi.org/10.1177/1756283X16651855. Epub 2016 Jun 7

    Article  PubMed  PubMed Central  Google Scholar 

  41. Matsubara S, Sasahira N, Isayama H et al (2016) Prospective pilot study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: long-term outcomes. Endosc Int Open 04:E1215–E1222

    Article  Google Scholar 

  42. Sharaiha RZ, Novikov A, Weaver K et al (2019) Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience. Endosc Int Open 07:E1419–E1423

    Article  Google Scholar 

  43. Tringali A, Vadalà di Prampero SF, Landi R, et al (2018) Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2018.08.019. Epub ahead of print

  44. Yamada T, Ogura T, Okuda A, et al. Pilot study of dumbbell-type covered self-expandable metal stent deployment for benign pancreatic duct stricture (with Videos). J Gastrointest Surg. https://doi.org/10.1007/s11605-018-3901-z. Epub ahead of print 2018

  45. Lee YN, Moon JH, Park JK et al (2020) Preliminary study of a modified, nonflared, short, fully covered metal stent for refractory benign pancreatic duct strictures (with videos). Gastrointest Endosc 91:826–833

    Article  Google Scholar 

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Conflict of Interest

None of the authors report conflicts of interest with regard to this manuscript.

Author information

Authors and Affiliations

  1. Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Laurent Monino & Pierre H. Deprez

Authors
  1. Laurent Monino
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  2. Pierre H. Deprez
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Corresponding author

Correspondence to Pierre H. Deprez .

Editor information

Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Monino, L., Deprez, P.H. (2020). Complications of Pancreatic Stents. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_99-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_99-1

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  • Print ISBN: 978-3-030-29964-4

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