Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video)

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• 作者：Dongwook Oh ; MD ; Do Hyun Park ; MD ; PhD ; Min Keun Cho ; MD ; Kwangwoo Nam ; MD ; Tae Jun Song ; MD ; PhD ; Sang Soo Lee ; MD ; PhD ; Dong-Wan Seo ; MD ; PhD ; Sung Koo Lee ; MD ; PhD ; Myung-Hwan Kim ; MD ; PhD
• 关键词：ERP ; endoscopic retrograde pancreatography ; EUS-PD ; EUS-guided pancreatic duct drainage ; FCSEMS ; fully covered self-expandable metal stent ; IQR ; interquartile range ; MPD ; main pancreatic duct
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：83
• 期：2
• 页码：366-373.e2
• 全文大小：1882 K

文摘

Recently, EUS-guided pancreatic duct drainage (EUS-PD) has been used for patients in whom endoscopic retrograde pancreatography (ERP) has failed. Stent-related adverse events such as stent migrations, failures in stent placement, or pancreatic fluid leakages have been of concern in transmural plastic stenting procedures. The aim of this study is to evaluate the feasibility and safety of EUS-PD with a fully covered self-expandable metal stent (FCSEMS) for patients with obstructive pancreatitis who failed ERP.

Methods

Twenty-five consecutive patients with painful obstructive pancreatitis underwent EUS-PD with a FCSEMS after failed ERP. Technical and clinical success, adverse events, and stent patency were assessed.

Results

EUS-PD was successful in all 25 patients (technical success rate, 100%), and symptoms improved in all patients (clinical success rate, 100%). EUS-guided pancreaticogastrostomy (n = 23), pancreaticoduodenostomy (n = 1), and pancreaticojejunostomy (n = 1) were performed. Pain scores improved significantly after FCSEMS placement (P = .001). Early mild grade adverse events occurred in 5 patients (20%), 4 with self-limited abdominal pain and 1 with minor bleeding. No other adverse events related to FCSEMS, including stent migration, stent clogging, pancreatic sepsis, and stent-induced ductal stricture, were observed during follow-up periods. Mean stent patency duration was 126.9 days during mean follow-up periods (221.1 days).

Conclusions

EUS-PD with an FCSEMS may be technically feasible and relatively safe for patients who fail conventional ERP. Further randomized trials comparing EUS-PD with long-term FCSEMS and plastic stents for patients with painful obstructive pancreatitis after failed ERCP should be encouraged.