When is a Pancreatic Stent used?

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Pancreatic stent

Pancreatic stent is a tiny tube which is placed in the pancreatic duct to drain obstructed pancreatic ducts. Pancreatic duct stents are frequently kept in patients who have chronic pancreatitis or a condition called ‘pancreatic divisum’. The employment of these stents is contentious and the results are erratic. Numerous pancreatic duct stents placed for a long duration or stents that are left in the pancreatic duct for extended periods of time can cause chronic condition called ‘pancreatitis’ in few patients. Pancreatic duct stents should be employed only after careful consideration of other treatment alternatives that are available for treatment of chronic pancreatitis.

 

What is Pancreatic Endotherapy?

Pancreatic endo therapy is a medical procedure that has been largely used for the treatment of several pancreatic disorders such as chronic pancreatitis, idiopathic acute recurrent pancreatitis, pancreatic duct leaks or disruptions, drainage of pseudocysts, and the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). One of the most common types of pancreatic endotherapy is pancreatic stenting.

 

Why pancreatic stenting is used?

Stenting of the major pancreatic duct has been used to relieve ductal obstruction, frequently in the setting of refractory pain from strictures, stones, or papillary stenosis. Additionally, stenting of the minor papilla has been used in the treatment of conditions such as indicative pancreas divisum secondary to a stenotic minor papilla. It is also used to prevent procedure-induced pancreatitis.

 

What is pancreatic psuedocyst?

Pancreatic pseudocyst is a compilation of fluid that is present around the pancreas when a patient develops severe or chronic pancreatitis. Pancreatic pseudocyst is a lake of pancreatic juice that has leaked from a damaged pancreatic duct. Pseudocysts form when the regular healing process closes of the pancreatic juice collections around the pancreas to form restricted fluid collections.

 

How is the drainage of pancreatic psuedocyst performed with the pancreatic stent?

  •  Pseudocysts are treated by draining the cyst fluid into a loop of intestine or the stomach.
  •  Endoscopic treatment is an alternative that is available for treating pseudocysts.
  •  During endoscopic treatment a stent or a small tube is placed between the stomach or the duodenum and the cyst so that the cyst drains into the gastrointestinal tract.
  •  One more optional technique is to pass a tiny catheter through the pancreatic duct and into the cyst if the cyst is communicating with the pancreatic duct.
  •  The patients are selected carefully for this treatment of pancreatic pseudocyst with endoscopic methods.
  •  Even though, this method cures the pseudocyst in some patients, severe infective risks that need multifaceted surgical techniques by introducing bacteria into the cyst may occur.

 

What are the other reasons for pancreatic stenting?

Stents may be placed to make sure that bile can drain liberally from the pancreas. A general motive for a pancreatic stent for drainage is pancreatic cancer. This can obstruct the bile duct and makes the bile to accumulate. This causes jaundice and can cause ache and uneasiness in people.

 

How does a pancreatic stent appear?

Each stent is suggested for use with stent introducer components including

  •  Aguide wire
  •  Pushing catheter and
  •  Positioning sleeve.

The positioning sleeve is used to disintegrate the duodenal flap on the stent and helps introduction into the endoscope accessory channel. Guidewires differ in diameter (0.018", 0.021", 0.025", and 0.035") and length, and may be hydrophilic, straight, with a "J" tip, or a loop tip. A few guide wires are Teflon-coated, which offers the maximum stability for stent placement and accessory exchanges.

 

How does a pancreatic stent work?

Traditiaonl pancreatic stents uses a central lumen and small side holes to provide drainage through the inside of the stent. However, that design, does not sufficiently permit fluid exchange through the many secondary ducts which connect with the main pancreatic duct. Current design of the pancreatic stent utilizes a winged perimeter, which channels fluids along the outside of the stent, rather than through a traditional central lumen. Consequently, fluids move resourcefully and successfully. By channeling fluids on the stent's exterior, this new stent minimizes any blockage of secondary pancreatic ducts. Also, the soft, flexible retention flaps make the stents easy to work with.

 

Is pancreatic stenting successful in preventing ERCP-induced pancreatitis?

Positioning of pancreatic stents is a fairly new and increasingly adopted approach to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Proof for the effectiveness of pancreatic stents in reducing post-ERCP pancreatitis continues to accumulate. Routine use of pancreatic stents in high-risk cases at advanced centers has changed the complexion of ERCP, reducing the incidence and severity of post-ERCP pancreatitis to a more acceptable level, and eliminating some of the fear factor surrounding previously prohibitively risky settings. On the other hand, the adoption of prophylactic pancreatic stenting into some practices has been irregular.

 

What are the risks of pancreatic stent?

Problems with pancreatic stent placement include:

  •  Technical difficulty with placement
  •  Requirement for follow-up evaluation to ensure passage or removal, and
  •  Potential for inducing pancreatic ductal injury. 
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