Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Endoscopy. 2009 Dec;41(12):1095-8. doi: 10.1055/s-0029-1215317. Epub 2009 Nov 10.
Pancreatic duct stent placement is increasingly performed for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP); however stents can result in injury especially in normal ducts. The clinical significance and outcomes of subsequent endoscopic therapy are unknown. This study was a retrospective review of the management of symptomatic stent-induced pancreatic duct injury following stent placement for prevention of post-ERCP pancreatitis in eight patients with previously normal pancreatic ducts. Subsequent treatment included pancreatic sphincterotomy, balloon dilation of stricture, and placement of multiple 3 - 5-Fr soft polymer pancreatic stents. All patients showed improvement or resolution of pancreatic strictures. Five patients had resolution or substantial improvement of pain, one patient showed a fair response with repeated ERCPs, and two patients failed to respond and underwent total pancreatectomy with islet autotransplantation. Pancreatic duct stent-induced ductal injury with significant clinical consequences can occur with conventional polyethylene stents. Endoscopic therapy is moderately effective but some patients develop irreversible damage. Caution should be used when placing standard polyethylene stents in normal ducts. Further research is required to identify safer materials and configurations of pancreatic stents.
胰腺管支架置入术越来越多地用于预防内镜逆行胰胆管造影术（ERCP）后的胰腺炎；然而，支架可能会导致损伤，尤其是在正常胆管中。随后内镜治疗的临床意义和结果尚不清楚。本研究回顾性分析了 8 例先前正常胰管患者因预防 ERCP 后胰腺炎而行支架置入术后出现症状性支架诱导性胰管损伤的治疗情况。后续治疗包括胰管括约肌切开术、狭窄球囊扩张和置入多个 3-5Fr 软聚合物胰管支架。所有患者的胰管狭窄均有改善或缓解。5 例患者疼痛缓解或明显改善，1 例经多次 ERCP 检查后反应良好，2 例患者无反应，行全胰切除术和胰岛自体移植。常规聚乙烯支架可导致具有显著临床后果的胰管支架诱导性导管损伤。内镜治疗效果中等，但部分患者发生不可逆转的损伤。在正常胆管中放置标准聚乙烯支架时应谨慎。需要进一步研究以确定更安全的胰管支架材料和结构。
