title: Temporary placement of a fully covered self-expandable metal stent in the pancreatic duct for management of symptomatic refractory chronic pancreatitis: preliminary data (with videos).
abstract: BACKGROUND
  Pancreatic duct (PD) stenting is beneficial for the treatment of pain in patients with PD strictures associated with chronic pancreatitis. Placement of metal stents has been reported but failed secondary to hyperplasia or migration.
  
  
  OBJECTIVE
  To investigate the outcome of patients with symptomatic and refractory PD strictures who had temporary placement of a covered self-expandable metal stent (CSEMS).
  
  
  METHODS
  Patients with refractory PD strictures were offered temporary CSEMS placement. Pain scores were evaluated before and after CSEMS placement.
  
  
  METHODS
  A tertiary-care center.
  
  
  METHODS
  Six patients (4 men, mean age +/- SD 55 +/- 8 years) received a CSEMS, and 5 patients had removal of a CSEMS after a mean time of 92 days.
  
  
  METHODS
  Placement of CSEMS (8-mm or 10-mm diameter VIABIL) in the PD, with removal after 3 months.
  
  
  METHODS
  The pain score before and after stent placement and the sustained response after removal. Morbidity associated with stent placement and removal was also noted.
  
  
  RESULTS
  Pain scores after CSEMS placement significantly improved (P = .024), from 6.4 to 1.6. Of the 5 patients who underwent CSEMS removal, 3 developed recurrent symptomatic pancreatic stricture, of whom 2 required repeat stenting with a larger-diameter CSEMS (10 mm) and 2 remained pain free. The CSEMS was not removed in 1 patient because pancreatic malignancy was diagnosed. There were no complications during placement or removal of CSEMSs.
  
  
  CONCLUSIONS
  This was a pilot study.
  
  
  CONCLUSIONS
  Temporary placement of CSEMSs in patients with symptomatic refractory PD stricture offers transient relief of pain. Further investigation is needed to determine the optimal diameter and duration of placement.
authors.affiliation: Digestive Health Center, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Sauer
authors.forename: Jayant
authors.initials: J
authors.lastname: Talreja
authors.forename: Kristi
authors.initials: K
authors.lastname: Ellen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ku
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors