Endotherapy for Pain in Chronic Pancreatitis

Sudeep Khanna; Rakesh K. Tandon

Disclosures

J Gastroenterol Hepatol. 2008;23(11):1649-1656. 

In This Article

Does Stent Blockage Warrant Stent Change, and How Can Stent Blockage be Prevented?

Ideally, pancreatic stents should be long enough to bridge the most proximal stricture, while short enough not to cause ductal changes. According to data from retrospective studies, this ideal goal is achieved in only one out of every five patients.[77] However, every second patient had persistent improvement in symptoms. This can be explained on the basis that either ductal hypertension was not the sole mechanism of pain or stent patency was still sufficient.

The interval for change of stent is difficult to assess. Various studies have reported a scheduled stent exchange very 3-6 months for up to 1 year, or stent extraction with replacement in case of difficult passage of a 6-Fr catheter or incomplete drainage.[32,34,43] Comparable results have been reported with stent change only when patients had a relapse of pain.[31] In a recent study of 100 patients, stent exchange was done only if there was relapse of pain.[78] Patients were followed up for a median period of 69 months (range 14-163 months) after entry into the study, including a median 27 months (range 12-126 months) following stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2-134 months). After attempted definitive stent removal, 30 patients (30%) required re-stenting within the first year of follow-up, while the remaining 70% experience adequate pain relief. By the end of follow-up, 38 patients had required re-stenting, and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002). There were no infectious complications. These results indicate that stent patency is not essential for pain relief because nearly all pancreatic stents are occluded by 9 weeks after their placement.[65,72] Conversely, it is unlikely that stent occlusion per se is sufficient to cause clinical infection.[79]

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