Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis
Fully covered self-expanding metal stents for refractory pancreatic duct strictures in chronic pancreatitis
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DOI：
10.1055/s-0032-1309774
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发表时间：
2012-09-01
期刊：
影响因子：
9.3
通讯作者：
Laugier, R.
中科院分区：
文献类型：
--
作者：
Giacino, C.;Grandval, P.;Laugier, R.
可从胆管中取出的全覆膜自膨式金属支架（FC-SEMSs）最近已用于慢性胰腺炎的主胰管（MPD）。本研究的目的是探讨FC-SEMSs治疗慢性胰腺炎伴顽固性胰腺狭窄的可行性、安全性和有效性。主要终点为技术成功率和手术相关发病率。次要终点是随访结束时疼痛缓解和内镜逆行胰管造影时主要胰腺狭窄消退。在5个月内，10例患有疼痛性慢性胰腺炎和难治性显性胰管狭窄的患者接受了FC-SEMS治疗。所有FC-SEM均成功释放并取出，但有两枚支架在其远端嵌入MPD中并进行了内镜治疗，未发生并发症。3例患者在支架释放后出现轻度腹痛。在治疗过程中，9名患者的疼痛得到缓解，但1名患者因成瘾继续服用吗啡。两名患者发生胆汁淤积，并接受内镜治疗;没有患者发生急性胰腺炎或胰腺脓毒症。支架取出后，直径的最大的MPD狭窄显着增加，从3.5毫米至5.8毫米。患者平均随访19.8个月：两名患者谁继续饮酒轻度急性胰腺炎，一名患者进一步发展慢性胰腺疼痛，和一个有短暂的疼痛发作。在研究结束时，9名患者不再有慢性疼痛，没有患者需要手术。通过置入FC-SEMS内镜治疗慢性胰腺炎难治性MPD狭窄似乎是可行、安全和潜在有效的。
Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective.