Mt. Smith et al., ALTERATIONS IN PANCREATIC DUCTAL MORPHOLOGY FOLLOWING POLYETHYLENE PANCREATIC STENT THERAPY, Gastrointestinal endoscopy, 44(3), 1996, pp. 268-275
Background: Polyethylene stents placed in the main pancreatic duct ind
uce morphologic alterations that may resemble chronic pancreatitis. Me
thods: We reviewed the sequential pancreatograms of stented patients w
ho had long-term follow-up after stent removal. Results: Forty patient
s (66%) had a normal baseline pancreatogram, whereas 21 (34%) showed c
hanges of chronic pancreatitis. In 49 of 61 patients (80.3%), one or m
ore had new morphologic changes immediately after stent withdrawal gra
ded as mild (69%), moderate (29%), or severe (2%). Changes included du
ctal irregularity (49%), narrowing (35.5%), and side branch change(15.
5%). Sixteen of the 21 patients (76.1%) with an abnormal baseline panc
reatogram had worsening of the baseline abnormality or additional chan
ges while stented, whereas 33 of 40 (82.5%) with a normal baseline dev
eloped new morphologic changes. Correlation of stent-induced changes w
ith stent size, length, patency at removal, and duration of stenting f
ailed to show an association. Twenty-five patients with stent-induced
changes had a follow-up pancreatogram at a mean of 192 days (10 to 740
) after stent removal. There was complete resolution of the changes in
64%, partial resolution in 32%, and no improvement in 5%. Conclusion:
Morphologic changes induced by polyethylene pancreatic duct stents oc
curred in 80% of patients. More than one third of these changes did no
t resolve during the follow-up period. Because of concern over stent-i
nduced fibrosis, the use of pancreatic stents should remain largely ex
perimental.