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Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

In chronic pancreatitis, fully covered self-expanding metal stents (FCSEMS) are used to treat refractory pancreatic duct strictures. However, the FCSEMS design, effectiveness, safety, optimal stent indwelling time and patient selection remain unclear. This study aimed at evaluating technical success, clinical success and adverse events with FCSEMS in patients with symptomatic pancreatic duct stricture.

Methods

The prospective study was conducted between May 2017 and May 2021 at a tertiary care center for chronic pancreatitis with refractory pancreatic duct stricture using controlled radial expansion (CRE) endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS (Niti-S, Bumpy stent, Taewoong Medical, Gimpo-Si, South Korea).

Results

During the study period, a total of 11 patients underwent ERCP with FCSEMS for refractory pancreatic duct stricture. The mean age (± standard deviation, [SD]) was 32.36 ± 10.98 years and nine patients (81%) were male. Technical and clinical success rates were 100% and 90.9%, respectively. All patients had a history of prior pancreatic endotherapy. The median (inter quartile range, [IQR]) stent indwell time was seven (6–10) months. The median visual analogue scale (VAS) pain score pre and post-FCSEMS was 8 (5–8) and 1 (0–2), respectively (p-value 0.003). Median (IQR) follow-up after stent removal was 48 (40–60) months. One patient (9%) developed de novo main pancreatic duct (MPD) stricture, which was asymptomatic. None of the patients had cholangitis, pancreatitis, perforation, proximal migration or stent fracture.

Conclusion

The FCSEMS treatment appears to be safe, feasible and possibly an effective option for patients who have not responded to endoscopic plastic stenting.

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Acknowledgements

We thank the endoscopy staff for their cooperation in the completion of the study.

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Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal,  Mayank & Ravi V. Krishna Kishore

  2. Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India

    Prabhaker Mishra

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Correspondence to Praveer Rai.

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Conflict of interest

PR, PK, AK, SA, KA, M, RVKK and PM declare that they have no conflict of interest. This is an independent study with independently drawn protocols and conclusions. It has not been authorized or sponsored by Boston Scientific Corporation or its Affiliates.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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12664_2023_1445_MOESM1_ESM.png

Supplementary Fig. 1. (PNG 94 KB) Box plot showing the significant decrease in VAS pain score between pre-and post-FCSEMS intervention. FCSEMS fully covered self-expandable metal stent, VAS visual analogue scale

Supplementary Fig. 2. (PNG 322 KB) Study flow chart

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Rai, P., Kumar, P., Kumar, A. et al. Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study. Indian J Gastroenterol (2023). https://doi.org/10.1007/s12664-023-01445-6

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