Endoscopy 2019; 51(04): S147
DOI: 10.1055/s-0039-1681603
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 13:30 – 14:00: ERCP pancreas 2 ePoster Podium 4
Georg Thieme Verlag KG Stuttgart · New York

ERCP WITH DRILLING USING SOHENDRA EXTRACTOR FOR STENTING NARROW AND IMPASSABLE MAIN DUCT STRICTURES IN CHRONIC CALCIFYING PANCREATITIS: A LARGE RETROSPECTIVE STUDY

JM Gonzalez
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
,
JP Le Mouel
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
,
M Barthet
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The management of symptomatic chronic pancreatitis (CP) requires stenting of the main pancreatic duct (MPD), to calibrate strictures, sometimes non crossable except by the wire. We describe our experience using Sohendra extractor to cross the obstruction for stent placement. The objectives were: to assess the technical success (ability to place a stent), and to elucidate the characteristics of the management, the factor associated with failure, and the complications.

Methods:

This is a retrospective study conducted between 2005 and 2017 in a tertiary center. All patients having undergone a drilling of MPD with Sohendra extractor strictures between 2004 and 2018 were included. Demographical, clinical and endoscopic characteristics were recorded.

Results:

101 patients (mean age 53.3 ± 12.8 years old, sex-ratio 2 M/1F) mostly with alcoholic CP, having undergone 180 MPD drilling were included. The site of the stricture was cephalic, isthmic, corporeo-caudal or diffuses in 50%, 22%, 17% and 11% of cases, respectively. Fifty-nine patients had one single drilling (58%), other patients had 2 (21%), 3 (11%) or > 4 (10%) drillings during separate ERCPs. I was performed during the first ERCP in 32% of cases.

The technical success was 93% (167/180). The Sohendra extractor diameter was 7Fr in 43% and 10Fr in 57% of cases. Then, a plastic stent was placed in 97% of cases (n = 164), mostly 7Fr. During the following ERCP, a stent exchange was possible in 67% of cases. If not, a successful new drilling was performed in most cases (83%). The complication rate was 4.5%, essentially benign pancreatitis (n = 6) and bacteriemia without sepsis (n = 2).

In multivariate analysis, the predictive factors for failure were a drilling performed during the first ERCP (virgin papilla; p = 0.038) and a diameter of the Sohendra extractor of 7Fr (p = 0.016).

Conclusions:

MPD drilling using Sohendra extractor is a simple, inexpensive, safe and effective approach for treating difficult strictures in CP.