Takuma Kensuke, Okano Naoki, Kimura Yusuke, Hoshi Kensuke, Sato Yoichiro, Ujita Wataru, Iwata Shuntaro, Nakagawa Hiroki, Watanabe Koji, Yamada Yuto, Iwasaki Susumu, Igarashi Yoshinori, Matsuda Takahisa
Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
J Gastroenterol Hepatol. 2024 Dec;39(12):2746-2751. doi: 10.1111/jgh.16733. Epub 2024 Sep 3.
Stent-induced ductal change is a complication of endoscopic pancreatic stent placement for chronic pancreatitis, potentially leading to irreversible changes that may contribute to pancreatic dysfunction. This study aimed to examine the long-term outcomes of stent-induced ductal change and evaluate factors that correlate with the development of irreversible ductal changes.
Between January 2008 and December 2022, 52/223 patients with chronic pancreatitis in whom an S-type plastic stent was successfully placed from the main papilla for duct stricture were detected with stent-induced ductal change on pancreatography at stent removal. We retrospectively investigated the clinical features of patients whose main pancreatic duct was reassessed by endoscopic pancreatography after >1 month without stent and whose residual stent-induced ductal change was irreversible.
The patients with chronic pancreatitis with stent-induced ductal change (n = 28) (elevated change, 15; stricture change, 13) were evaluated using follow-up pancreatography. Eleven patients (39.3%) showed residual change associated with stent-induced ductal change, the degree of which was partial improvement, no change, and obstructive change in one, seven, and three patients, respectively. Stricture changes during stent removal and duration of stent placement that triggered ductal changes were significantly associated with the development of residual ductal changes.
Irreversible stent-induced ductal change in patients with chronic pancreatitis was associated with stricture changes in the main pancreatic duct and continued plastic-stent placement. Careful evaluation of the pancreatic duct is required during plastic-stent placement. Early plastic-stent removal may result in an effective response to the development of stent-induced ductal change.
支架诱导的导管改变是慢性胰腺炎内镜下胰管支架置入术的一种并发症，可能导致不可逆的改变，进而引起胰腺功能障碍。本研究旨在探讨支架诱导的导管改变的长期结局，并评估与不可逆导管改变发生相关的因素。
2008年1月至2022年12月期间，223例慢性胰腺炎患者中，有52例经主乳头成功置入S型塑料支架以治疗导管狭窄，在支架取出时经胰管造影检测到支架诱导的导管改变。我们回顾性研究了在无支架状态下超过1个月后通过内镜胰管造影再次评估主胰管且残余支架诱导的导管改变为不可逆的患者的临床特征。
对发生支架诱导的导管改变的慢性胰腺炎患者（n = 28）（升高改变15例，狭窄改变13例）进行随访胰管造影评估。11例患者（39.3%）显示存在与支架诱导的导管改变相关的残余改变，其程度分别为部分改善、无变化和梗阻性改变，其中1例、7例和3例患者。支架取出时的狭窄改变以及引发导管改变的支架置入持续时间与残余导管改变的发生显著相关。
慢性胰腺炎患者中不可逆的支架诱导的导管改变与主胰管狭窄改变及塑料支架持续置入有关。在置入塑料支架期间需要仔细评估胰管。早期取出塑料支架可能会有效应对支架诱导的导管改变的发生。
