Stent retriever for dilation of pancreatic and bile duct strictures

Background and Study Aims: Dilation of high grade strictures of pancreatic or biliary ducts using dilating or balloon catheters may fail. We evaluated the efficacy of the 7-Fr Soehendra Stent Retriever used as a dilator. Patients ann Methods: Following sphincterotomy, the stricture was first neg otiated with a 260 cm long 0.032-inch J-type Terumo wire. Dilation was then attempted using a 7-Fr dilating catheter, If the stricture could not be tr aversed, the 7-Fr Stent Retriever aas inserted over the Terumo wire to dila te the stricture. Between May 1996 and January 1997, the Stent Retriever wa s used for dilation in 32 patients with biliary or pancreatic duet strictur es. Results: The indication for therapeutic endoscopic retrograde cholangiopanc reatography, (ERCP) was symptomatic chronic pancreatitis in 21 patients (tw elve men, nine women; mean age 45.7, range 26-70), The mean length (+/- SD) of the pancreatic duct strictures was 20 mm +/- 10 (range 3-55) with a pre stenotic ductal diameter of 9 mm +/- 2 (range 2-15), Out of 21 patients, ni ne suffered from pancreaticolithiasis and were treated with extracorporeal shock wave lithotripsy. All but three patients underwent successful stentin g in the same session. Another 11 patients (four men, seven women; mean age 67.4, range 47-85) had cholestasis because of benign or malignant bile duc t strictures. The mean length of the strictures was 20 mm +/- 5 (range 3-40 ), and the mean prestenotic diameter was 10 mm +/- 5 (range 4-21), Stenting was easily done in ail of these patients in the same session. Symptom reli ef was observed within the first week after stenting in all patients with a biliary or pancreatic stricture. In seven cases, material for cytological examination was obtained from the bile duct, which revealed malignancy in t wo cases. There was no complication associated with the use of the Stent Re triever. One subcapsular liver perforation was caused by the guide wire and occurred prior to the use of the Retriever. Conclusions: Tight pancreatic and bile duct strictures can be dilated succe ssfully with the Stent Retriever. The procedure is of low risk, In addition , tissue sampling is possible in some eases.