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home - Pancreas - Other - Pancreatic Stenting Written by Dr Sebastian Zeki

Pancreatic Stenting

Pancreatic stenting and its complications Immediate complications -24%Pancreatitis, pain, and ductal rupture from bougienage.Early complications -18%Bleeding, pancreatitis, and a guidewire fracture requiring surgical removal of the broken fragment,acute cholangitisLate complicationsStent-related ductal changesInflammation-related oedema and ductal narrowing @ proximal end of the stentStent occlusionSimilar occlusion rate as biliary stentsAssoc with pain or acute pancreatitis-Pain occurs only in 6% of those with clogStent migrationUsually upstream> 80 % of migrated pancreatic stents can be retrieved endoscopically. Pancreatic Duct StonesStents used in:...-Main pancreatic duct sphincterotomy-Facilitation of extra corporeal shock wave lithotripsy-Stones associated with pancreatic duct stricture.-Incomplete stone extractionFactors which favor stone removal include:-3 or fewer stones-Stones confined to head and/or body of pancreas-Stone size <10 mm-Absence of impacted stones/ downstream stricturesMultiple stones, large stones, or those associated with strictures require a combination of sphincterotomy, ESWL, stricture dilation, and/or stent placement. Pancreatic Duct StricturesIndicated if pain in presence of a strictureOutcomes: relief of pain in 80 %, and good long-term outcomes in 60%.PseuodocystsTranspapillary stent placement for pseudocysts that communicate with the main pancreatic duct. Pancreatic Duct DisruptionsTranspapillary stenting for refractory pancreatico-cutaneous fistulas, pancreatic ascites, pleural effusion, and pancreatic-enteric fistulas.Stents are usually retrieved after 4-6 weeks. Pancreas DivisumStenting of minor papilla used diagnostically and therapeutically Recurrent Idiopathic Acute PancreatitisStenting may be indicated but not well studied Prevention of pancreatitis after pancreatic sphincterotomyPancreatitis rate: pancreatic sphincterotomy > biliary sphincterotomy esp with pancreatic sphincter hypertension.Insertion of a stent may prevent this Indications 10mm 1. Change the stents regularly2. Short stents better than long3. Avoid stents that extend beyond the genu of the pancreas (prevents migration) Prevention Complications: Written by Dr Sebastian Zeki