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Migration of Internal Pancreaticojejunostomy Stents into the Bile Ducts in Patients Undergoing Pancreatoduodenectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

To investigate the incidence, complications, and risk factors of the migration of internal pancreaticojejunostomy (PJ) stents into the bile ducts in patients undergoing pancreatoduodenectomy.

Methods

Postoperative computed tomography (CT) and clinical data of 802 patients with CT-detectable internal PJ stents were reviewed to assess the occurrence of stent migration into the bile ducts and stent-induced complications with their clinical significance. Risk factors for stent migration and stent-induced complications were determined.

Results

Stent migration into the bile ducts occurred in 135 patients (16.8 %); 40 of these (29.6 %) showed stent-induced complications including bile duct stricture, stone, and liver abscess. Clinically significant complications were identified in only eight patients. Neither the stent length nor diameter was associated with stent migration. A small stent diameter, peripheral location of the stent, absence of stent remigration from the bile ducts to the intestine, and longer stent retention time in the bile ducts were risk factors of stent-induced complications.

Conclusions

The incidence of internal PJ stent migration into the bile ducts was 16.8 %. Migrated stents frequently caused complications, although they were mostly subclinical. Stent-induced complications were associated with stent diameter and location, stent remigration to the intestine, and stent retention time in the bile ducts.

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References

  1. Bartoli FG, Arnone GB, Ravera G, Bachi V. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res 1991;11:1831-1848.

    CAS  PubMed  Google Scholar 

  2. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248-260.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931-939.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kawai M, Kondo S, Yamaue H, Wada K, Sano K, Motoi F, Unno M, Satoi S, Kwon AH, Hatori T, Yamamoto M, Matsumoto J, Murakami Y, Doi R, Ito M, Miyakawa S, Shinchi H, Natsugoe S, Nakagawara H, Ohta T, Takada T. Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2011;18:601-608.

    Article  PubMed  Google Scholar 

  5. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000;232:786-795.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Kamoda Y, Fujino Y, Matsumoto I, Shinzeki M, Sakai T, Kuroda Y. Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy. Surg Today 2008;38:524-528.

    Article  PubMed  Google Scholar 

  7. Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Shimizu A, Yamaue H. A prospective randomized controlled trial of internal versus external drainage with pancreaticojejunostomy for pancreaticoduodenectomy. Am J Surg 2010;199:759-764.

    Article  PubMed  Google Scholar 

  8. Moriya T, Clark CJ, Kirihara Y, Kendrick ML, Reid Lombardo KM, Que FG, Farnell MB. Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy. Arch Surg 2012;147:35-40.

    Article  PubMed  Google Scholar 

  9. Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD, Choti MA, Coleman J, Hodgin MB, Sauter PK, Sonnenday CJ, Wolfgang CL, Marohn MR, Yeo CJ. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 2006;10:1280-1290.

    Article  PubMed  Google Scholar 

  10. Xiong JJ, Altaf K, Mukherjee R, Huang W, Hu WM, Li A, Ke NW, Liu XB. Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy. Br J Surg 2012;99:1050-1061.

    Article  CAS  PubMed  Google Scholar 

  11. Zhou Y, Zhou Q, Li Z, Lin Q, Gong Y, Chen R. The impact of internal or external transanastomotic pancreatic duct stents following pancreaticojejunostomy. Which one is better? A meta-analysis. J Gastrointest Surg 2012;16:2322-2335.

    Article  PubMed  Google Scholar 

  12. Bawany MZ, Rafiq E, Thotakura R, McPhee MD, Nawras A. Successful management of recurrent biliary colic caused by pancreatic stent migration after Whipple procedure. J Interv Gastroenterol 2012;2:97-98.

    PubMed Central  PubMed  Google Scholar 

  13. Kadowaki S, Miura F, Amano H, Toyota N, Wada K, Shibuya M, Maeno S, Takada T, Sano K. Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy. J Hepatobiliary Pancreat Sci 2012;19:566-577.

    Article  PubMed  Google Scholar 

  14. Price LH, Brandabur JJ, Kozarek RA, Gluck M, Traverso WL, Irani S. Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents. Gastrointest Endosc 2009;70:174-179.

    Article  PubMed  Google Scholar 

  15. Rezvani M, O'Moore PV, Pezzi CM. Late pancreaticojejunostomy stent migration and hepatic abscess after Whipple procedure. J Surg Educ 2007;64:220-223.

    Article  PubMed  Google Scholar 

  16. Ortega PM, Zozaya-Larequi G, Arredondo J, Marti-Cruchaga P, Bellver M, Sanchez-Justicia C, Rotellar F, Pardo F. Distal migration of a transanastomotic pancreatic stent resulting in bowel perforation 19 years after pancreatoduodenectomy: report of a case. Surg Today 2015;45:374-377.

    Article  PubMed  Google Scholar 

  17. Mari G, Costanzi A, Monzio N, Miranda A, Rigamonti L, Crippa J, Sartori P, Maggioni D. Small bowel perforation caused by pancreaticojejunal anastomotic stent migration after pancreaticoduodenectomy for periampullary carcinoma. JOP 2015;16:185-188.

    PubMed  Google Scholar 

  18. Biffl WL, Moore EE. Pancreaticojejunal stent migration resulting in “bezoar ileus”. Am J Surg 2000;180:115-116.

    Article  CAS  PubMed  Google Scholar 

  19. Arhan M, Odemis B, Parlak E, Ertugrul I, Basar O. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 2009;23:769-775.

    Article  PubMed  Google Scholar 

  20. Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992;38:341-346.

    Article  CAS  PubMed  Google Scholar 

  21. Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Paikos D, Zavos C, Karakousis K, Gelas G, Tzilves D. Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech 2009;19:217-221.

    Article  PubMed  Google Scholar 

  22. Kozarek RA. Pancreatic stents can induce ductal changes consistent with chronic pancreatitis. Gastrointest Endosc 1990;36:93-95.

    Article  CAS  PubMed  Google Scholar 

  23. Levy MJ, Chari S, Adler DG, Clain JE, Gostout CJ, Harewood GC, Pearson RK, Petersen BT, Sarr MG, Farnell MB. Complications of temporary pancreatic stent insertion for pancreaticojejunal anastomosis during pancreaticoduodenectomy. Gastrointest Endosc 2004;59:719-724.

    Article  PubMed  Google Scholar 

  24. Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: An evidence-based approach. Clin Gastroenterol Hepatol 2004;2:273-285.

    Article  PubMed  Google Scholar 

  25. Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 1996;91:654-659.

    CAS  PubMed  Google Scholar 

  26. McMillan MT, Vollmer CM, Jr. Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg 2014;399:811-824.

    Article  PubMed  Google Scholar 

  27. Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, Sastre B, Arnaud JP, Federation de Recherche en C. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg 2011;253:879-885.

    Article  PubMed  Google Scholar 

  28. Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 2007;246:425-435.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg 2012;99:524-531.

    Article  CAS  PubMed  Google Scholar 

  30. Wang Q, He XR, Tian JH, Yang KH. Pancreatic duct stents at pancreaticoduodenectomy: a meta-analysis. Dig Surg 2013;30:415-424.

    Article  PubMed  Google Scholar 

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Conflicts of Interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, South Korea

    So Hyun Park, Jin Hee Kim, Seung Yeon Noh, Jae Ho Byun, Seung Soo Lee, Hyoung Jung Kim, Seong Ho Park & Moon-Gyu Lee

  2. Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, South Korea

    Sung Koo Lee

  3. Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, South Korea

    Dae Wook Hwang, Song Cheol Kim & Duck Jong Han

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  1. So Hyun Park
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  2. Jin Hee Kim
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Correspondence to Jin Hee Kim.

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Park, S.H., Kim, J.H., Noh, S.Y. et al. Migration of Internal Pancreaticojejunostomy Stents into the Bile Ducts in Patients Undergoing Pancreatoduodenectomy. J Gastrointest Surg 19, 1995–2002 (2015). https://doi.org/10.1007/s11605-015-2906-0

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  • DOI: https://doi.org/10.1007/s11605-015-2906-0

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