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Think outside the Stent

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ViaDuct™
Pancreatic Stents

References

Complete articles for these abstracts are available from GI Supply. They can be obtained by calling 800-451-5797.

Effect of a Novel Pancreatic Stent Design on Short?Term Pancreatic Injury in a Canine Model
Biliary and pancreatic stents
A survey of physician practices on prophylactic pancreatic stents
Prospective, randomized controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla

Effect of a Novel Pancreatic Stent Design on Short?Term Pancreatic Injury in a Canine Model

Raju GS, Gomez G, Xiao S.?Y, Ahmed I, Brining D, Bhutani MS, Kalloo AN, Pasricha PJ.

Endoscopy 2006;38:260-265

Background and Study Aims: Attempts to address the problem of injury to the pancreas by indwelling pancreatic stents are limited by our lack of knowledge of the pathogenesis of stent-induced injury and its relationship to stent morphology and the duration of stenting. The aim of our study was to evaluate pancreatic injury induced by 1 week of stenting with a 5F indwelling pancreatic stent of novel design, the "wing stent."

Methods: Pancreatic stents (5F) were placed surgically in eight dogs; wing stents (WS?5F) were used in four dogs and conventional stents (CS?5F) in another four. Two dogs underwent duodenotomy without stent placement (controls). The pancreas was harvested for microscopy at 1 week. A pathologist who was unaware of the source of the specimens graded the pancreatic injury.

Results: Although pancreatic injury was observed in both the CS–5F and WS–5F groups after 1 week of indwelling pancreatic stenting, it was considerably less severe in the WS–5F group compared with the CS–5F group (1.01 ± 0.10 vs. 1.63 ± 0.14, P < 0.01). All components of pancreatic injury were affected, with the most dramatic differences noted in inflammation, fibrosis, and edema. The differences were most marked in the stented segment (P < 0.001) and in the upstream segment of the pancreas (P < 0.05).

Conclusions: Indwelling conventional pancreatic stents can cause significant pancreatic injury even when left in place for only 1 week. A wing design can significantly ameliorate stent?induced changes.

A copy of this article is available from GI Supply.

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Biliary and pancreatic stents

Technology Assessment Committee, Bret T Petersen MD, Chair, et al., American Society for Gastrointestinal Endoscopy

Gastrointest Endosc 2006;63:910-919

Background: Stents are tubular devices, made of plastic or metal, designed to maintain or enhance the patency of a lumen. Recently, a stent with a star-shaped cross-section has been developed for pancreatic applications. During endoscopic retrograde cholangiopancreatography (ERCP), biliary and pancreatic stents are commonly employed in the management of bile duct and pancreatic duct obstructions and leaks, which result from a variety of conditions. Pancreatic stents are also used for prevention of post-ERCP pancreatitis. The decision to deploy biliary or pancreatic stents, and stent selection, should involve consideration of their efficacy, safety, and cost. This review addresses these issues for the wide variety of plastic and metal stents.

Methods: ASGE Technology Committee review.

Summary: Plastic biliary stents are easy to insert, inexpensive, easily removed, and effective for a wide variety of indications. Metal stent placement can be justified for patients with inoperable cancer who are expected to survive ? 6 months. Metal stents are currently not approved for benign disorders. Pancreatic stents have gained acceptance for management of several benign pancreatic conditions and reduction of post-ERCP pancreatitis in high-risk patients.

A copy of this article is available from GI Supply.

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A survey of physician practices on prophylactic pancreatic stents

Stephen Brackbill, MD, Scott Young, MD, Philip Schoenfeld, MD, Grace Elta, MD

Gastrointest Endosc 2006;64:45-51

Background: Several prospective studies confirm that prophylactic stent placement in the pancreatic duct (PD) during high-risk ERCP procedures decreases the risk of post-ERCP pancreatitis. Inconsistencies exist regarding the indications for prophylactic PD stent placement, the type of stent used, and stent follow-up.

Objective: To assess the current practice patterns of expert biliary endoscopists regarding prophylactic pancreatic duct stents.

Design: An anonymous survey was mailed to 54 expert biliary endoscopists, assessing volume of procedures, stent indications, method of placement, and follow-up.

Results: A total of 91% (49/54) of surveys were returned and analyzed. Prophylactic PD stents were used by 96% of respondents. Stent use was universal during ampullectomy and pancreatic sphincterotomy. Most also used stents for minor papillotomy (93%) and sphincter of Oddi dysfunction (SOD) confirmed by manometry (82%). Endoscopists disagreed on the following: pre-cut sphincterotomy (71%), prior post-ERCP pancreatitis (64%), suspected SOD (58-69%), and traumatic sphincterotomy (44%). Endoscopists used straight stents (33%), pigtail stents (30%), or a combination (33%). Internal flanges were always used by 14%, never used by 54%, and sometimes used by 32%. Stent size and length varied widely, as did the time stents were left in place, and the retrieval method.

Conclusions: Expert biliary endoscopists agree that prophylactic PD stenting is indicated during ERCP in high-risk patients. Wide variation exists in patient selection and stent placement technique.

A copy of this article is available from GI Supply.

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Prospective, randomized controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla

Gavin C. Harewood, MD, MSc, Nicole L. Pochron, LPN, Christopher J. Gostout, MD

Gastrointest Endosc 2005;62:367-70

Background: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safety of endoscopic excision of the papilla. Although there is consensus about prophylactic pancreatic-duct stent placement, there is little supporting prospective data. The aim of this randomized, controlled trial was to compare the rates of postsnare ampullectomy pancreatitis in patients who did/did not receive prophylactic pancreatic-duct stent placement.

Methods: Consecutive patients who were to undergo en bloc snare ampullectomy were randomized to placement of pancreatic-duct stent after ampullectomy or to no stent placement.

Results: In total, 19 patients were enrolled, and 10 received pancreatic stents. Postprocedure pancreatitis occurred in 3 patients in the 24 hours after endoscopy, all cases occurred in the unstented group, 33% vs. 0% (stented group), p = 0.02. Median peak amylase level was 3692 U/L (range 1819-4700 U/L) and median peak lipase level was 11450 U/L (range 5900-17,000 U/L). All 3 patients were hospitalized for a median of 2 days (range 1-6), and all made a complete recovery.

Conclusions: Our findings suggest that a protective effect is conferred by pancreatic stent placement in reducing postampullectomy pancreatitis. Future large-scale studies are required to confirm this benefit.

A copy of this article is available from GI Supply.

Request this product to experience its benefits to your practice. You may also place your order and request samples by calling 800-451-5797.

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