Shah BB1, Rodge GA1, Goenka U2, Afzalpurkar S, Goenka MK1

1Institute of Gastrosciences & Liver, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal, India, 2Department of Clinical Imaging and Interventional Radiology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal, India

Background/Aims: Fully covered self-expanding metal stents (FCSEMS) is a relatively novel option to treat refractory pancreatic duct strictures. We aimed to assess the feasibility, safety, and efficacy of FCSEMS in patients with chronic pancreatitis with refractory pancreatic duct strictures.

Methods: This is a prospective single centre study of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement in the main pancreatic duct (MPD) at a tertiary care centre. The primary endpoints were technical success and clinical success. Secondary endpoints were resolution of the pancreatic stricture on fluoroscopy during ERCP and the development of stent-related adverse events.

Results: Thirty-six patients were analyzed. All of the patients had prior therapy. The technical success rate for FCSEMS placement was 100% (n=36) and the clinical success rate was 86.1% (n=31). Stents were removed after a median duration of 156 days. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 1.7mm to 3.5mm (P<0.001). There was a statistically significant improvement in pain score on the visual analog scale from a median of 7.5 to 2. Long-term outcomes were evaluated in 18 patients, with 55.6% asymptomatic patients at a median follow-up of 19 months (Table 1). Stent migration (16.7%), intolerable abdominal pain (8.3%), development of denovo stricture (8.3%), and mild pancreatitis (2.8%) were the encountered adverse events.

Conclusion: FCSEMS is a feasible, safe, and potentially effective intervention with few adverse events in patients who do not respond to endoscopic therapy with a plastic stent.

Keywords: Refractory Pancreatic Stricture, FCSEMS, Efficacy, Adverse events