Long-term outcomes of fully covered self-expandable metal stents versus plastic stents in chronic pancreatitis

Sang Hoon Lee,Yeon Suk Kim,Seung Woo Park,Hee Seung Lee,Si Young Song,Eui Joo Kim,Jeong Youp Park,Seungmin Bang,Jae Hee Cho

doi:10.1038/s41598-021-94726-z

Abstract

Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n = 26) and plastic stent (n = 54) for persistent MPD strictures after at least 3 months of initial single plastic stenting, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p < 0.001). Although immediate complications occurred similarly (38.5% vs. 37.0%, p = 0.902), spontaneous migration (26.9%) and de novo strictures (23.1%) were pronounced delayed complications in FC-SEMS group. Pain relief during follow-up was significantly higher in FC-SEMS group (76.9% vs. 53.7%, p = 0.046). The total procedure cost was similar in both groups ($1,455.6 vs. $1,596.9, p = 0.486). In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures.

Highlights

Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists
Chronic pancreatitis (CP) is a benign, irreversible, inflammatory pancreatic disorder, which can result in various complications including symptomatic main pancreatic duct (MPD) stricture
Endoscopic pancreatic duct (PD) stenting with a single plastic stent has been mainly used for treatment of CP patients with symptomatic MPD strictures[2,3,4]

Summary

Introduction

Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. We aim to compare the long-term clinical efficacy of FC-SEMS vs plastic stent placement in persistent MPD strictures secondary to CP. In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures. Covered self-expandable metal stent (FC-SEMS) placement was lately introduced as an investigated treatment option for persistent MPD strictures after single plastic stenting[3]. Several published data have recently demonstrated clinical efficacy of FC-SEMS as a 37–88% pain improvement during a 3–4 year follow-up period[10,11,12] These pilot studies occurred at a single medical center, and were limited by a small sample size (10–18 patients). We aimed to compare the longterm clinical efficacy of FC-SEMS vs. plastic stent placement in CP patients with persistent MPD strictures after at least 3 months of single plastic stenting in two medical institutions

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Conclusion