4695 The frequency of altered duct morphology and natural history of patients following appropriate pancreatic duct stent management.

Abstract

Background: Studies describing alterations in duct morphology following pancreatic duct stent (PDS) placement have raised concerns about stentrelated morbidity. Limitations included small numbers and inconsistencies in PDS management (e.g. indications for and duration of stenting). The frequency of alterations in duct morphology attributable to appropriately managed PDS remains in doubt, and natural history following PDS removal has yet to be ascertained. Aims: (1) assess the frequency of alterations in duct morphology attributable to appropriately managed PDS, and (2) ascertain the natural history of patients following PDS removal. Methods: Review of endoscopic databases at U. Cincinnati and U. Kentucky. Patients who underwent PDS placement were identified. A data collection form and questionnaire were composed prior to chart review and patient telephone interviews. Exclusion criteria included malignancy, prior pancreatic surgery, alcohol use, and AIDS. In 69% of cases, PDS were either changed or removed within 8 weeks. Data included indication for PDS, ERP findings preceding PDS, stent diameter/length, ERP findings after PDS removal, and complications. Natural history data included physician visits for symptoms attributable to acute/chronic pancreatitis, pain, analgesic use, symptoms of malabsorption, and diabetes. Results: 41 patients were identified who met inclusion and exclusion criteria, 3 SOD and no pancreatitis, 13 acute pancreatitis (AP) (6 duct disruption, 5 SOD, 2 pancreas divisum), and 25 chronic pancreatitis (CP) (13 duct stricture, 7 duct disruption, 5 pancreas divisum). PDS ranged from 5 Fr - 11.5 Fr and 2.5 cm - 15 cm. ERP following stent removal was available in 1/3 SOD, 8/13 AP, and 17/25 CP patients (26/41 total). Alterations in ductal morphology attributable to PDS were noted in 0/1 SOD, 2/8 AP, and 2/17 CP patients (4/26 total). Natural history data was available on 2/3 SOD, 7/13 AP, and 12/25 CP patients (21/41 total). Mean follow-up from PDS placement was 15.6 months. Development/progression of symptoms attributable to pancreatic disease subsequent to PDS removal occurred in 0/2 SOD, 0/7 AP, and 5/12 CP patients. Conclusions: Alterations in duct morphology attributable to PDS were less frequent than previously reported. Acknowledging the limited follow-up time in these cohorts, few alterations in natural history attributable to PDS were identified. Prospective validation of the safety of appropriately managed PDS is warranted.