Pancreatic Duct (PD) Stenting with the Johlin Wedge Stent (JPWS) in Pancreatic Disease

Abstract

Purpose: Endoscopic management in pancreatic disorders is widely accepted. PD stenting for an obstructed/disrupted duct has been described. However, these stents are often placed short-term. We describe our experience with the JPWS in a series of pts. Methods: All pts, between October 2002 and May 2006, with findings of an obstructed/disrupted PD were evalulated for stent placement. ERCP was performed and an 8.5 or 10 Fr JPWS was placed. Pts were followed at either 12 or 24 week intervals with repeat ERCP ± stent exchange. Results: A total of 26 patients, ages 26 to 83 years, had ERCP with placement of the JPWS. A total of 44 stents were placed; 11 patients had serial stent placements. All pts had ductography changes of chronic pancreatitis (CP) by the Cambridge Classification or malignancy with stricture. The etiology of pancreatic disease in these pts was alcohol (8), idiopathic (6), malignancy (5), gallstone (2), hereditary (2), IPMN (1), p. divisum (1) and papillary stenosis (1). Indications for stent placement were 12 PD strictures, 7 PD disruptions (3 pseudocysts, 2 pseudocysts with pancreatic ascites, 2 pancreaticopleural fistulas) and 7 PD stones. 37 were placed in the main PD; 7 were placed in the dorsal duct. Follow-up was pobbible in 23 of the 26 patients (88%). 3 patients had stent removal within 14 days, 2 for abdominal pain and 1 for bacteremia of unknown source. Of the remaining 20 patients, 9 had resolution of their symptoms and underlying process; 6 patients remain with a JPWS in place and continue with marked symptom improvement. 4 pts died from their underlying malignancy. The remaining pt went for surgery shortly after stent placement for pancreatic head malignancy. In 2 patients at interval ERCP, the stents were noted to partially migrate distal into the duodenum, but they remained asymptomatic. There were no clinical stent occlusion events. Stents remained in the PD between 49 and 455 days with a mean length of 178 days. There were no complications related to length of time the stent remained intraductal. Conclusions: Placement of the JPWS is effective in the management of pts with symptoms due to pancreatic disease. Palliation of abdominal pain and resolution of leakage and stricturing occurred in the majority of patients alleviating the need for surgical intervention. In addition, these stents may be safely left in place for more than 24 weeks allowing for less frequent stent exchanges.