Are large side holes associated with reduced rates of pancreatic stent occlusion? Results of a prospective study.
BACKGROUND
Pancreatic stents are frequently clogged at the time of removal. There is limited data regarding the factors associated with stent occlusion.


OBJECTIVE
To estimate the frequency of stent occlusion at the time of removal, to study the accuracy of endoscopic prediction of occlusion, and to determine the factors associated with clogged pancreatic stents.


METHODS
Consecutive patients at 4 academic medical centers undergoing removal of a previously placed pancreatic stent were prospectively enrolled.


METHODS
A total of 68 patients were enrolled between August 2007 and July 2008.


METHODS
Following removal, stent occlusion was immediately assessed by complete lack of water flow from the duodenal end and side holes of the stent.


METHODS
Survival analysis was performed using a Kaplan-Meier and Cox Regression model.


RESULTS
Indications for stent placement included chronic pancreatitis (n=23), pancreatic duct leak (n=7), prevention of post-ERCP pancreatitis (n=28), pseudocyst drainage (n=1), pancreas divisum (n=8), and pancreatic duct stricture without chronic pancreatitis (n=1). Standard Geenen (Cook Endoscopy, Winston-Salem, NC, USA) pancreatic stents were placed in 53 patients (77.9%). The majority of stents (42, 61.8%) were completely occluded at the time of removal. Median time to stent occlusion was 35 days (95% CI: 30-40 days). Stent type, diameter, length, number of small side holes, and indication for placement were not predictive of subsequent stent occlusion. However, stents with at least 4 large, flange-associated side holes were 54% less likely to be clogged upon removal (HR=0.46, P=0.029).


CONCLUSIONS
Pancreatic stents are mostly occluded as early as 1 month after insertion. Larger side holes may prevent stents within the pancreas from becoming clogged.
Buscaglia
Jonathan M
JM
Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. jmbuscaglia@notes.cc.sunysb.edu
DiMaio
Christopher J
CJ
Pollack
Michael J
MJ
Shin
Eun Ji
EJ
Harris
Michael D
MD
Richards
Robert
R
Chak
Amitabh
A
Kantsevoy
Sergey V
SV
Jagannath
Sanjay B
SB
Okolo
Patrick I
PI
D020878:Device Removal / Q000009:adverse effects / Q000706:statistics & numerical data; D004322:Drainage / Q000379:methods; D004868:Equipment Failure / Q000706:statistics & numerical data*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000453:epidemiology*; D008954:Models, Biological; D010179:Pancreas / Q000293:injuries / Q000601:surgery*; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis