Placement of a novel fully covered metallic stent for refractory pancreatic duct stricture

Plastic stent placement under endoscopic retrograde cholangiopancreatography is performed widely for the treatment of benign pancreatic stricture [1]. However, this technique may have several disadvantages such as short stent patency and persistent stricture compared with fully covered metallic stents (FCMS) [2] [3]. Therefore, although FCMS placement for benign pancreatic stricture is still controversial as a result of a relatively high rate of stent migration (especially distal migration), the FCMS has a potential clinical impact in patients with symptomatic chronic pancreatitis. This report describes the placement of a novel FCMS (6 mm × 6 cm, Niti-S Biliary S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea; Century Medical Inc., Tokyo, Japan) in patients with chronic pancreatitis who have refractory pancreatic duct stricture ([Fig. 1]). This novel FCMS has a long removal suture, and therefore, if distal stent migration does occur, the stent can be removed easily by grasping the suture thread.

Fig. 1 Fully covered metallic stent with long suture (6 mm × 6 cm, Niti-S Biliary S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea; Century Medical Inc., Tokyo, Japan).

A 66-year-old man was admitted to the Osaka Medical College Hospital with abdominal pain caused by pancreatic stent occlusion. He had undergone placement of a 10-Fr plastic stent 1 month earlier for pancreatic duct stricture caused by chronic pancreatitis. Despite several stent exchanges, the pancreatic duct stricture persisted. Therefore, it was decided to place a novel FCMS.

First, the plastic stent was removed, and contrast medium was injected into the main pancreatic duct. A pancreatic duct stricture of the pancreatic head was seen ([Fig. 2]). Next, the novel metallic stent delivery system (8 Fr) was inserted through the stenosis site ([Fig. 3]), and the stent was successfully placed ([Fig. 4], [Video 1]). No adverse events occurred and the patient was discharged. After 6 months, no late adverse events, including stent migration, were observed.

Fig. 2 The pancreatic duct stricture was seen in the pancreatic head (arrows).

Fig. 3 The fully covered metallic stent delivery system (8 Fr) was inserted into the pancreatic duct.

Fig. 4 The stent was successfully placed from the pancreatic body to the head across the stricture site. a Fluoroscopic image. b Endoscopic image.

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The contrast medium was injected into the pancreatic duct, and a stricture was seen in the pancreatic head. A fully covered metallic stent delivery system was inserted, and the stent was successfully placed.

This stent may be a safer device because if the stent migrates it can be retrieved easily by grasping the long suture thread. However, results from a prospective study with long term follow-up are needed to confirm this.

Endoscopy_UCTN_Code_TTT_1AR_2AZ

Competing interests: None

• References

• 1 Adler DG, Lichtenstein D, Baron TH et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 2006; 63: 933-937
• 2 Park do H, Kim MH, Moon SH et al. Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic strictures: a pilot study (with video). Gastrointest Endosc 2008; 68: 1182-1189
• 3 Moon SH, Kim MH, Park do H et al. Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc 2010; 72: 86-91