Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis & disconnected pancreatic duct syndrome.
BACKGROUND
There is limited data on the long term consequences and safety profile of long term indwelling transmural stents after successful treatment of walled off pancreatic necrosis (WOPN).


OBJECTIVE
To retrospectively evaluate consequences of long term indwelling transmural stents in patients with WOPN.


METHODS
The records of patients who underwent endoscopic transmural drainage of WOPN and had disconnected pancreatic duct syndrome (DPDS) were analyzed.


RESULTS
Thirty patients (26 M; mean age 37.1 ± 7.8 years) with long term indwelling transmural stents and DPDS were followed up for a mean of 20.4 ± 12.2 months (range: 3-38 months). The etiology of acute necrotizing pancreatitis was alcohol in 21, gall stones in 7 and idiopathic in 2 patients. In all patients two or three, 7 (17 patients) or 10 Fr (13 patients) 5 cm double pigtail stents were placed. ERCP revealed disconnected PD at the pancreatic head, body and tail region in 22, 7, and 1 patient respectively. Five patients (16.6%) had spontaneous migration of stents (both the stents in four patients and one stent in one patient; 7 Fr in four and 10 Fr in one patient respectively). Stent migration led to recurrence of pancreatic fluid collection (PFC) in one patient whereas in the remaining 4 patients it did not cause any symptoms. There was no recurrence of symptomatic PFC in remaining 25 patients.


CONCLUSIONS
Long term indwelling transmural stents in patients with WOPN and DPDS seem to be safe and also appear to decrease the risk of PFC recurrence.
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India. Electronic address: drsurinderrana@yahoo.co.in.
Surinder Singh
SS
Rana
Deepak Kumar
DK
Bhasin
Chalapathi
C
Rao
Ravi
R
Sharma
Rajesh
R
Gupta
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005548:Foreign-Body Migration; D006801:Humans; D010179:Pancreas / Q000000981:diagnostic imaging / Q000601:surgery; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014463:Ultrasonography
Acute pancreatitis; Computed tomography; Endoscopic ultrasound; Stents