Matsunami Yukitoshi, Itoi Takao, Sofuni Atsushi, Tsuchiya Takayoshi, Kamada Kentaro, Tanaka Reina, Tonozuka Ryosuke, Honjo Mitsuyoshi, Mukai Shuntaro, Fujita Mitsuru, Yamamoto Kenjiro, Asai Yasutsugu, Kurosawa Takashi, Tachibana Shingo, Nagakawa Yuichi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Endosc Int Open. 2018 May;6(5):E505-E512. doi: 10.1055/s-0044-101753. Epub 2018 Apr 18.
Endoscopic ultrasonography-guided pancreatic duct drainage (EUS-PD) has been reported as an alternative for failed conventional endoscopic retrograde cholangiopancreatography (ERCP). However, there are few dedicated devices for EUS-PD. Recently, we have developed a new plastic stent dedicated to EUS-PD and have conducted a feasibility study to evaluate its efficacy. In the current study, we evaluated the long-term efficacy of this new plastic stent.
Thirty patients (61 ± 14.3 years old, 14 men) with acute recurrent pancreatitis caused by a stricture in the main pancreatic duct (MPD) or stenotic pancreatoenterostomy were treated at our institution using our recently developed 7Fr plastic stent between August 2013 and April 2017.
The stent was placed successfully in all patients (30/30) and early clinical success was achieved in all of them. Early adverse events (AEs) occurred in seven patients (23.3 %), namely, self-limited abdominal pain (n = 5), mild pancreatitis (n = 1), and bleeding which required transcatheter arterial embolization (n = 1). Two patients died of primary disease and three were lost to follow-up. The remaining 25 patients were followed up after initial EUS-PD for a median of 23 months (range, 6 - 44 months). Twenty patients required regular stent exchange (3 times; range, 1 - 12 times). Spontaneous stent dislodgement was observed in six patients. Four patients wanted their stents removed 1 year after the initial intervention. Twelve patients (48 %) had regular stent exchange 1 year after the initial intervention. Three patients converted to standard transpapillary pancreatic duct stenting by conventional ERCP. Finally, nine patients (36 %) had complete stent removal either intentionally or by spontaneous dislodgement without any symptoms.
The new plastic stent for EUS-PD was associated with not only short-term technical success but also long-term clinical success in the majority of patients evaluated in this study.
内镜超声引导下胰管引流术（EUS-PD）已被报道可作为传统内镜逆行胰胆管造影术（ERCP）失败后的替代方法。然而，用于EUS-PD的专用器械较少。最近，我们研发了一种专门用于EUS-PD的新型塑料支架，并进行了一项可行性研究以评估其疗效。在本研究中，我们评估了这种新型塑料支架的长期疗效。
2013年8月至2017年4月期间，我们机构使用最近研发的7Fr塑料支架对30例因主胰管（MPD）狭窄或胰肠吻合口狭窄导致急性复发性胰腺炎的患者（年龄61±14.3岁，男性14例）进行了治疗。
所有患者（30/30）均成功置入支架，且全部取得早期临床成功。7例患者（23.3%）发生早期不良事件（AE），即自限性腹痛（n = 5）、轻度胰腺炎（n = 1）以及需要经导管动脉栓塞治疗的出血（n = 1）。2例患者死于原发性疾病，3例失访。其余25例患者在初次EUS-PD后接受了中位时间为23个月（范围6 - 44个月）的随访。20例患者需要定期更换支架（3次；范围1 - 12次）。6例患者出现支架自发移位。4例患者在初次干预1年后希望取出支架。12例患者（48%）在初次干预1年后进行了定期支架更换。3例患者通过传统ERCP转为标准经乳头胰管支架置入术。最后9例患者（36%）通过有意或自发移位完全取出支架，且无任何症状。
在本研究评估的大多数患者中，用于EUS-PD的新型塑料支架不仅取得了短期技术成功，还获得了长期临床成功。
