Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.408
Peer-review started: November 11, 2017
First decision: December 13, 2017
Revised: December 20, 2017
Accepted: December 26, 2017
Article in press: December 26, 2017
Published online: January 21, 2018
Processing time: 70 Days and 21 Hours
To evaluate the use of fully covered self-expandable metal stents (FCSEMSs) for pancreatic duct strictures in children with chronic pancreatitis.
Eight patients with refractory benign dominant stricture of the main pancreatic duct (MPD) were enrolled through chart reviews between December 2014 and June 2017 in a single center. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a 6-mm FCSEMS with dual flaps was performed. Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. All procedures were performed by a pediatric gastroenterologist. For the assessment of outcomes, technical and clinical success, adverse events, and stent patency were evaluated retrospectively.
The placement and removal of the FCSEMSs were successful in all 8 patients. Five patients were boys and 3 were girls. The median age at initial FCSEMS placement was 12 years (range, 5-18 years). The diameters of all the inserted stents were 6 mm, and the lengths were 4-7 cm. The median indwelling time was 6 mo (range, 3-10 mo). No pancreatic sepsis, pancreatitis, cholestasis, or mortality occurred. There was no proximal and distal migration. All subjects showed a patent stent. On follow-up ERCP, the mean diameter of the stricture improved from 1.1 mm to 2.8 mm (P < 0.05), whereas that of upstream dilation improved from 8.4 mm to 6.3 mm (P < 0.05).
This initial experience showed that temporary FCSEMS placement is feasible and safe for the management of refractory benign MPD stricture in children.
Core tip: This study reports the initial experience with the use of fully covered self-expandable metal stents (FCSEMSs) for recurrent benign pancreatic duct strictures in children. We indwelled 6-mm FCSEMSs with dual flaps in the pancreatic duct of pediatric patients for 6 mo. The placement and removal of the FCSEMSs were technically and clinically successful. There were no adverse events or stent obstruction. The findings support the applicability of FCSEMSs to the pediatric population.