Shah Bhavik Bharat, Rodge Gajanan Ashokrao, Goenka Usha, Afzalpurkar Shivaraj, Goenka Mahesh Kumar
Institute of Gastrosciences & Liver, Apollo Multispeciality Hospital, Kolkata, India.
Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospital, Kolkata, India.
Clin Endosc. 2022 Nov;55(6):793-800. doi: 10.5946/ce.2021.211. Epub 2022 Apr 4.
BACKGROUND/AIMS: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.
背景/目的：全覆膜自膨式金属支架（FCSEMSs）是治疗慢性胰腺炎患者疼痛性主胰管难治性狭窄的一种相对新颖的选择。在此，我们旨在评估FCSEMSs在该患者群体中的疗效、可行性和安全性。
这项前瞻性单中心研究纳入了接受内镜逆行胰胆管造影术并放置FCSEMSs的患者。主要终点是技术成功率和临床成功率。与支架置入前相比，视觉模拟评分疼痛评分降低>50%被定义为临床成功。次要终点是内镜逆行胰胆管造影术中透视下胰管狭窄的缓解情况以及支架相关不良事件的发生情况。
36例患者纳入分析。技术成功率为100%（n = 36），临床成功率为86.1%（n = 31）。支架取出后狭窄直径从1.7 mm显著增加至3.5 mm（p<0.001）。平均视觉模拟评分疼痛评分有统计学意义的改善。随访19个月时，55.6%的患者无症状。支架移位（16.7%）、难以忍受的腹痛（8.3%）、新发狭窄的形成（8.3%）和轻度胰腺炎（2.8%）是最常见的不良事件。
FCSEMS置入术在难治性主胰管狭窄患者中实现疼痛缓解方面显示出良好的技术和临床成功率。
