Takikawa Tetsuya, Kume Kiyoshi, Tanaka Yu, Kikuta Kazuhiro, Ogata Yohei, Hatta Waku, Hamada Shin, Miura Shin, Matsumoto Ryotaro, Sano Takanori, Sasaki Akira, Hayashi Hidehiro, Sakano Misako, Manaka Tomoo, Masamune Atsushi
From the Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Pancreas. 2025 Jan 1;54(1):e30-e38. doi: 10.1097/MPA.0000000000002392. Epub 2024 Sep 12.
Endoscopic pancreatic stenting (EPS) is an effective treatment for painful chronic pancreatitis. However, little is known about the factors that cause pain recurrence after stent removal, and there are no clear criteria for stent removal. We aimed to develop a prediction model for pain recurrence by identifying its risk factors.
We retrospectively reviewed 95 patients who underwent EPS for pain for the first time using a single plastic stent between January 2007 and July 2022 at our institute. Univariate and multivariate stepwise Cox proportional hazards models were used to identify the risk factors for pain recurrence, and a prediction model was developed based on the identified factors.
Of the 95 enrolled patients, 89 (93.7%) achieved pain relief and 73 (76.8%) did stent removal. Among 69 patients with a follow-up period ≥6 months after stent removal, 29 (42.0%) had pain recurrence during the median follow-up of 59 months. Serum lipase level ( P = 0.034) and pancreatic parenchymal thickness ( P = 0.022) on computed tomography or magnetic resonance imaging were identified as independent risk factors for pain recurrence. The prediction model based on the identified factors had good discrimination ability, with a concordance index of 0.74, and could stratify pain recurrence rates.
We identified the risk factors and developed a new prediction model for pain recurrence following stent removal. This model might be useful for decision making in pancreatic stent management, such as deciding whether to remove a stent, continue EPS, or convert to surgery.
内镜下胰管支架置入术（EPS）是治疗疼痛性慢性胰腺炎的有效方法。然而，对于支架取出后疼痛复发的原因知之甚少，且尚无明确的支架取出标准。我们旨在通过识别疼痛复发的危险因素来建立一个预测模型。
我们回顾性分析了2007年1月至2022年7月在我院首次使用单个塑料支架进行EPS治疗疼痛的95例患者。采用单因素和多因素逐步Cox比例风险模型识别疼痛复发的危险因素，并基于识别出的因素建立预测模型。
95例入选患者中，89例（93.7%）疼痛缓解，73例（76.8%）取出支架。在69例支架取出后随访时间≥6个月的患者中，29例（42.0%）在中位随访59个月期间出现疼痛复发。计算机断层扫描或磁共振成像上的血清脂肪酶水平（P = 0.034）和胰腺实质厚度（P = 0.022）被确定为疼痛复发的独立危险因素。基于识别出的因素建立的预测模型具有良好的区分能力，一致性指数为0.74，并且可以分层疼痛复发率。
我们识别了危险因素，并建立了一个新的支架取出后疼痛复发预测模型。该模型可能有助于胰管支架管理的决策，例如决定是否取出支架、继续进行EPS或转为手术治疗。
