Overview of pancreatic stenting and its complications
- Marc F Catalano, MD, FACG, FACP, FASGE, AGAF
Marc F Catalano, MD, FACG, FACP, FASGE, AGAF
- The University of Texas Health Science Center at Houston
- Professor of Medicine, Department of Internal Medicine, Division of Gastroenterology
- Director, Memorial Hermann Southeast Endoscopy & Chief of Therapeutic Endoscopy
- Director of UT-MHH Advanced Endoscopy Training Program
- Vivek Kaul, MD, FACG
Vivek Kaul, MD, FACG
- Associate Professor of Medicine
- University of Rochester Medical Center
Pancreatic endotherapy has been increasingly used for the treatment of a variety of pancreatic disorders including chronic pancreatitis, idiopathic acute recurrent pancreatitis, pancreatic duct leaks or disruptions, drainage of pseudocysts, and the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP).
One of the most common types of pancreatic endotherapy is pancreatic stenting. Stenting of the main pancreatic duct has been used to relieve ductal obstruction, often in the setting of refractory pain from strictures, stones, or papillary stenosis. In addition, stenting of the minor papilla has been used in the treatment of symptomatic pancreas divisum secondary to a stenotic minor papilla . The indications, efficacy and complications related to pancreatic stents will be reviewed here. The role of pancreatic stents to prevent ERCP-induced pancreatitis is discussed in detail separately. (See "Prophylactic pancreatic stents to prevent ERCP-induced pancreatitis: When do you use them?".)
INSTRUMENTS AND TECHNIQUES
A variety of guidewires, dilators, and stents are available. The choice of instruments will depend upon the clinical setting.
Guidewires — Guidewires vary in diameter (0.018", 0.021", 0.025", and 0.035") and length, and may be hydrophilic, straight, have a "J" tip, or a loop tip. They are available with various radiopaque markings to minimize fluoroscopy time. Some guidewires are Teflon-coated, which provides the greatest stability for stent placement and accessory exchanges. Electrically insulated wires can be left in place during sphincterotomy. Glidewire and "Roadrunner" are special wires used for difficult cannulation and access at ERCP.
Dilators — Two types of dilators are most commonly used: balloon dilators and dilating catheters. Balloon dilators are inflation devices housed on a catheter, which are used to deliver a specific pressure to a strictured or stenosed area. They are available in several diameters and lengths. An inflation device is required to pressurize the balloon at a controlled rate.
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- INSTRUMENTS AND TECHNIQUES
- Pancreatic duct stones
- - Main pancreatic duct sphincterotomy
- - Facilitation of extra corporeal shock wave lithotripsy
- - Stones associated with pancreatic duct strictures
- - Incomplete stone extraction
- Pancreatic duct strictures
- Pancreatic duct disruptions
- Pancreas divisum
- Recurrent idiopathic acute pancreatitis
- Pancreatic sphincterotomy
- Early complications
- Late complications
- - Stent-related ductal changes
- - Stent occlusion
- - Stent migration
- - Indications and endoscopist experience
- - Stent choice and replacement
- - Nasopancreatic stents
- - Pancreatic stenting and removal technique
- SUMMARY AND RECOMMENDATIONS