scholarly journals Risk Factors for Migration, Fracture, and Dislocation of Pancreatic Stents

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yoshiaki Kawaguchi ◽  
Jung-Chun Lin ◽  
Yohei Kawashima ◽  
Atsuko Maruno ◽  
Hiroyuki Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Stent Migration ◽  
Success Rates ◽  
Patient Factors ◽  
Minor Papilla ◽  
Stent Retrieval ◽  
Duct Stenosis ◽  
Pancreatic Sphincterotomy

Aim. To analyze the risk factors for pancreatic stent migration, dislocation, and fracture in chronic pancreatitis patients with pancreatic strictures.Materials and Methods. Endoscopic stent placements (total 386 times) were performed in 99 chronic pancreatitis patients with pancreatic duct stenosis at our institution between April 2006 and June 2014. We retrospectively examined the frequency of stent migration, dislocation, and fracture and analyzed the patient factors and stent factors. We also investigated the retrieval methods for migrated and fractured stents and their success rates.Results. The frequencies of stent migration, dislocation, and fracture were 1.5% (5/396), 0.8% (3/396), and 1.2% (4/396), respectively. No significant differences in the rates of migration, dislocation, or fracture were noted on the patient factors (etiology, cases undergoing endoscopic pancreatic sphincterotomy, location of pancreatic duct stenosis, existence of pancreatic stone, and approach from the main or minor papilla) and stent factors (duration of stent placement, numbers of stent placements, stent shape, diameter, and length). Stent retrieval was successful in all cases of migration. In cases of fractured stents, retrieval was successful in 2 of 4 cases.Conclusion. Stent migration, fracture, and dislocation are relatively rare, but possible complications. A good understanding of retrieval techniques is necessary.

scholarly journals Motion - Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments for the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 57-59
Author(s):  
Stanley M Branch
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Clinical Problem ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Ducts ◽  
Success Rates ◽  
Long Term Follow Up

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

scholarly journals 556 A Prospective Review of Risk Factors, Clinical Presentation and Management Outcomes for Chronic Pancreatitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Akula ◽  
K Sugumar ◽  
A Deshpande
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Statistical Correlation ◽  
Pain Severity ◽  
Female Ratio ◽  
Pain Scores ◽  
Duct Diameter ◽  
Imaging Characteristics

Abstract Aim and objectives: To identify the risk factors, symptoms, and severity of Chronic pancreatitis (CP) on admission. To determine the relationship between pancreatic duct diameter and severity of pain and to assess extent of pain relief achieved by medical, endoscopic, and surgical intervention. Method 75 patients with CP were admitted over 2 years. Data collected included etiology, symptoms, pain scores and CT/MRCP findings. Patients were classified into mild, moderate, and severe category according to Cambridge classification. Type and response to treatment was recorded. Statistical correlation of the pancreatic duct diameter and pain severity as well as the comparison of pain scores after medical, surgical and endoscopy was performed using Chi square test (p value <0.05) Results Median age of presentation of CP was 43 years. Male: female ratio was 3:1. Alcohol was the etiology in 66 %, 99% presented with pain, 65 % belonged to severe category. There was no statistical correlation between pain severity and duct diameter. Pain relief following medical management was 66 %, endoscopic - 73% and surgical - 83 %. There was no correlation between Cambridge classification and pain severity. There was no statistical difference between pain relief offered by either of the three modalities. However, there was a statistically significant correlation between duct diameter and type of intervention. Conclusions There is no consensus on the best treatment modality for CP as pain relief was equivalent amongst all the modalities. Therefore, the choice of intervention for patients suffering from chronic pancreatitis should be based on imaging characteristics and symptomology.

scholarly journals Endoscopic Retrieval Technique of Proximally Migrated Pancreatic Stents: A Retrospective Study in a Tertiary Centre

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yi Lu ◽  
Zheng Jin ◽  
Jia-chuan Wu ◽  
Li-ke Bie ◽  
Biao Gong
Keyword(s):  
Retrospective Study ◽  
Adverse Events ◽  
Pancreatic Duct ◽  
Clinical Information ◽  
Stent Migration ◽  
Point Of View ◽  
Pancreatic Stent ◽  
Success Rates ◽  
Tertiary Centre ◽  
Endoscopic Retrieval

Background. There were scarce trials concerning the treatments and outcomes of proximal pancreatic stent migration. Herein, we did a retrospective study to discuss this problem from an endoscopist’s point of view.Patients and Methods. From January 2009 to June 2014, patients with proximally migrated pancreatic duct stents were identified. Their clinical information was viewed. Retrieval techniques, success rates, and adverse events were analyzed.Results. A total of 36 procedures were performed in 34 patients; the median age of the patients was 53 years, with 17 males and 17 females. Eight patients’ pancreatic duct stents could still be seen in the major or minor papilla and were pulled out with a snare forceps or a grasping forceps; in the remaining 28 procedures, the management was somewhat thorny; the retrieval called for several devices. Final success was achieved in 31 patients. No adverse event was observed in the process of ERCP procedures, 5 patients developed post-ERCP pancreatitis (PEP), 1 patient got infection, and 1 patient had haemorrhage.Conclusions. Endoscopic retrieval of migrated pancreatic stent is safe and less invasive; nonetheless, attention should be paid so as to reduce the incidence and degree of related adverse events, especially PEP.

scholarly journals Motion – Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments Against the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 61-63 ◽  
Author(s):  
Darwin L Conwell
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Major Complication ◽  
Difficult Problem ◽  
Pancreatic Pseudocysts ◽  
Success Rates ◽  
Endoscopic Techniques ◽  
Large Numbers ◽  
Pancreatic Disorders

Endoscopic therapy can be used to dilate strictures in the pancreatic duct, remove stones and drain pseudocysts. In addition, it provides an alternative to surgery for the management of pain in patients with chronic pancreatitis. Pain is a difficult problem in these patients, especially if substance abuse is present, and its medical management is generally unsatisfactory. The concept that pancreatic pain is related to increased pressure in the main pancreatic duct is unproven, and is not supported by the results of surgical intervention. Although pancreatic stenting is often technically successful at achieving drainage of the pancreatic duct and relieving pain over the short term, pain usually recurs with time, complications are frequent, and repeated stent changes are usually necessary. Pancreatic pseudocysts can be drained endoscopically, using transpapillary, cystogastrostomy or cystoduodenostomy approaches, but success rates are less than 50% and bleeding is a major complication. Pseudocysts should not be drained unless they are symptomatic, causing complications or enlarging. There have been no published studies comparing endoscopic with surgical or radiological modalities. Endoscopic therapy of pancreatic disorders is a new and interesting technique, but initial promising results need to be confirmed in large, well-designed clinical trials. Such studies would need to enrol large numbers of patients, and involve measurement of technical success, pain severity and quality of life parameters. At present, endoscopic techniques must be considered experimental.

scholarly journals 10 Fr S-Type Plastic Pancreatic Stents in Chronic Pancreatitis Are Effective for the Treatment of Pancreatic Duct Strictures and Pancreatic Stones

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ken Ito ◽  
Naoki Okano ◽  
Seiichi Hara ◽  
Kensuke Takuma ◽  
Kensuke Yoshimoto ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Stones ◽  
Pancreatic Juice Cytology ◽  
Pancreatic Duct Stricture ◽  
Duct Stricture ◽  
Pancreatic Sphincterotomy

Aim. Endoscopic pancreatic stenting for refractory pancreatic duct strictures associated with impacted pancreatic stones in chronic pancreatitis cases has yielded conflicting results. We retrospectively evaluated the efficacy of endoscopic treatment in chronic pancreatitis patients with pancreatic duct strictures. Methods. Pancreatic sphincterotomy, dilatation procedures, pancreatic brush cytology, and pancreatic juice cytology were routinely performed, and malignant diseases were excluded. After gradual dilatation, a 10 Fr plastic pancreatic stent was inserted. The stents were replaced every 3 months and removed after the strictures were dilated. Statistical analyses were performed to determine the risk of main pancreatic duct restenosis. Results. Endoscopic pancreatic stents were successfully placed in 41 of a total of 59 patients (69.5%). The median duration of pancreatic stenting was 276 days. Pain relief was obtained in 37 of 41 patients (90.2%). Seventeen patients (41.5%) had recurrence of main pancreatic duct stricture, and restenting was performed in 16 patients (average placement period 260 days). During the follow-up period, pancreatic cancer developed in three patients (5.1%). Multivariate analysis revealed that the presence of remnant stones after stenting treatment was significantly associated with a higher rate of main pancreatic duct restenosis (p=0.03). Conclusion. The use of 10 Fr S-type plastic pancreatic stents with routine exchange was effective for both short-term and long-term outcomes in chronic pancreatitis patients with benign pancreatic duct strictures and impacted pancreatic stones.

scholarly journals Pancreatic Stones: Treat or Ignore?

1999 ◽  
Vol 13 (6) ◽  
pp. 461-465 ◽  
Author(s):  
DA Howell
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Therapeutic Endoscopy ◽  
Major Step ◽  
New Techniques ◽  
Nonsurgical Management ◽  
Extracorporeal Shock Wave ◽  
Pancreatic Duct Stones ◽  
Pancreatic Sphincterotomy

Painful, chronic pancreatitis is of complex etiology, but increasing clinical experience suggests that removal of pancreatic duct stones in many cases significantly improves patients’ symptoms. The development and refinement of therapeutic endoscopic retrograde choledochopancreatography have permitted improved access to the pancreatic duct, which makes the development of new techniques of stone fragmentation and fragment removal a much more successful nonsurgical intervention. A major step forward has been the understanding of the safety and efficacy of pancreatic sphincterotomy, which is necessary for the removal of these difficult stones. The recognition that extracorporeal shock wave lithotripsy can be delivered safely with good efficacy has revolutionized the nonsurgical management of pancreatic duct stones. Nevertheless, advanced and sophisticated therapeutic endoscopy is necessary to achieve clearance of the duct, which can generally be accomplished in the majority of selected patients. State-of-the-art treatments are described, and some new approaches using pancreatoscopy and electrohydrolic lithotripsy are discussed. Newly recognized long term complications are reviewed. Finally, it must be recognized that chronic pancreatitis is an ongoing disease that does not have a simple treatment or cure, and frequently represents a process of remissions and relapses requiring interventions and problem solving.

scholarly journals Case history of endoscopic stanting in complex treatment of chronic pancreatitis

2011 ◽  
Vol 3 (1) ◽  
pp. 40-45
Author(s):  
Dmitriy V. Sazonov ◽  
Alexey I. Pastuhov ◽  
Viktor N. Lesnyak ◽  
Margarita E. Semendyaeva
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Case History ◽  
Alternative Methods ◽  
Complex Treatment ◽  
History Of ◽  
Duct Stenosis

The problem of chronic pancreatitis treatment is very relevant. It makes more questions than answers. In case of pancreatic duct stenosis with super stenosis dilatation the endoscopic stanting may be one of alternative methods in complex treatment of chronic pancreatitis. We describe the case history of using this technology.

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