Takuma Kensuke, Okano Naoki, Kimura Yusuke, Watanabe Koji, Nakagawa Hiroki, Hoshi Kensuke, Miura Masashi, Tochigi Naobumi, Igarashi Yoshinori, Matsuda Takahisa
Division of Gastroenterology and Hepatology Toho University Omori Medical Center Tokyo Japan.
Department of Surgical Pathology Toho University Omori Medical Center Tokyo Japan.
DEN Open. 2025 Jan 13;5(1):e70050. doi: 10.1002/deo2.70050. eCollection 2025 Apr.
Stent-induced ductal change is a complication of endoscopic treatment of the main pancreatic duct in chronic pancreatitis. Most previous reports have been based on morphological duct changes observed via pancreatography. Here, we describe a case of stent-induced ductal change in which the course of the mucosal changes was observed through peroral pancreatoscopy with a videoscopy. The patient presented with chronic alcoholic pancreatitis. Main pancreatic duct stenosis in the pancreatic head was identified and a 10-Fr plastic stent was inserted. Follow-up pancreatography revealed a focally elevated duct change of approximately 4.5 mm at the distal tip of the stent, and peroral pancreatoscopy was performed. The elevated ductal change was identified as a clear villiform-like nodular mucosal change with the spread of pale papillary and granular mucosa. Reassessment after stent removal showed an improvement in the elevated mucosal lesion, with residual discoloration and mucosal retraction suggestive of scarring. The stent may cause irreversible changes, undetectable morphologically by pancreatography, likely underestimating stent-induced ductal change in chronic pancreatitis.
支架诱导的导管改变是慢性胰腺炎主胰管内镜治疗的一种并发症。以往大多数报告基于通过胰管造影观察到的形态学导管改变。在此，我们描述一例支架诱导的导管改变病例，其中通过带视频的经口胰管镜观察到黏膜改变的过程。该患者患有慢性酒精性胰腺炎。发现胰头主胰管狭窄并插入了一个10F的塑料支架。随访胰管造影显示支架远端尖端有一处约4.5毫米的局灶性导管升高改变，随后进行了经口胰管镜检查。升高的导管改变被确定为明显的绒毛状结节性黏膜改变，伴有淡色乳头和颗粒状黏膜的扩散。支架取出后的重新评估显示升高的黏膜病变有所改善，残留有变色和黏膜回缩，提示有瘢痕形成。支架可能会引起不可逆的改变，胰管造影在形态学上无法检测到，这可能低估了慢性胰腺炎中支架诱导的导管改变。
