Rai Praveer, Kumar Pankaj, Kumar Ashok, Asari Sana, Agarwal Kartik, Krishna Kishore Ravi V, Mishra Prabhaker
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Indian J Gastroenterol. 2023 Sep 28. doi: 10.1007/s12664-023-01445-6.
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.
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).
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.
The FCSEMS treatment appears to be safe, feasible and possibly an effective option for patients who have not responded to endoscopic plastic stenting.
在慢性胰腺炎中，全覆膜自膨式金属支架（FCSEMS）用于治疗难治性胰管狭窄。然而，FCSEMS的设计、有效性、安全性、最佳支架留置时间及患者选择仍不明确。本研究旨在评估FCSEMS治疗有症状胰管狭窄患者的技术成功率、临床成功率及不良事件。
本前瞻性研究于2017年5月至2021年5月在一家三级慢性胰腺炎护理中心进行，该中心使用可控径向扩张（CRE）内镜逆行胰胆管造影（ERCP）及FCSEMS（Niti-S，凹凸支架，韩国仁川市太宇医疗公司）治疗难治性胰管狭窄。
在研究期间，共有11例患者因难治性胰管狭窄接受了FCSEMS ERCP治疗。平均年龄（±标准差，[SD]）为32.36±10.98岁，9例患者（81%）为男性。技术成功率和临床成功率分别为100%和90.9%。所有患者均有胰腺内治疗史。支架中位留置时间（四分位间距，[IQR]）为7（6 - 10）个月。FCSEMS置入前后视觉模拟量表（VAS）疼痛评分中位数分别为8（5 - 8）和1（0 - 2）（p值0.003）。支架取出后的中位（IQR）随访时间为48（40 - 60）个月。1例患者（9%）出现新发主胰管（MPD）狭窄，无症状。无患者发生胆管炎、胰腺炎、穿孔、近端移位或支架断裂。
对于内镜下塑料支架置入无反应的患者，FCSEMS治疗似乎是安全、可行且可能有效的选择。
