title: 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.
abstract: BACKGROUND
  Fully covered self-expandable metal stent (FCSEMS) placement has recently been tried in the management of refractory pancreatic-duct strictures associated with advanced chronic pancreatitis. The major limitation of FCSEMSs was frequent migration.
  
  
  OBJECTIVE
  To assess the safety, migration rate, and removability of modified FCSEMSs with antimigration features used for the treatment of benign pancreatic-duct strictures.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary academic center.
  
  
  METHODS
  Thirty-two patients with chronic painful pancreatitis and dominant ductal stricture.
  
  
  METHODS
  Transpapillary endoscopic placement of FCSEMSs in the pancreatic duct with removal after 3 months.
  
  
  METHODS
  Technical and functional success and adverse events associated with the placement of metal stents.
  
  
  RESULTS
  FCSEMSs were successfully placed in all patients through the major (n = 27) or minor (n = 5) duodenal papilla. All patients achieved pain relief from stent placement. There was no occurrence of stent-induced pancreatitis or pancreatic sepsis. No stent migrated, and all stents were easily removed. Follow-up ERCP 3 months after stent placement showed resolution of duct strictures in all patients. Pancreatograms obtained at FCSEMS removal displayed de novo focal pancreatic duct strictures in 5 patients, but all were asymptomatic.
  
  
  CONCLUSIONS
  No long-term follow-up.
  
  
  CONCLUSIONS
  Temporary 3-month placement of FCSEMSs was effective in resolving pancreatic-duct strictures in chronic pancreatitis, with an acceptable morbidity profile. Modified FCSEMSs can prevent stent migration, but may be associated with de novo duct strictures. Further trials are needed to assess long-term safety and efficacy.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Moon
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Tae Joon
authors.initials: TJ
authors.lastname: Song
authors.forename: Junbum
authors.initials: J
authors.lastname: Eum
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic / Q000628:therapy; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000628:therapy*; D011446:Prospective Studies; D019233:Retreatment; D015607:Stents; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible