Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2018; 24(3): 408-414
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.408
Metal stents placement for refractory pancreatic duct stricture in children
In Sook Jeong, Sung Hee Lee, Seak Hee Oh, Do Hyun Park, Kyung Mo Kim
In Sook Jeong, Sung Hee Lee, Seak Hee Oh, Kyung Mo Kim, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children’s Hospital, Seoul 05505, South Korea
Do Hyun Park, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Jeong IS, Lee SH, Oh SH and Kim KM contributed to the conception and design of the study; all authors contributed to the study implementation, data acquisition, and data analysis; Jeong IS wrote the manuscript; and all authors contributed to the editing, reviewing, and final approval of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Asan Medical Center and University of Ulsan College of Medicine (2017-0210).
Informed consent statement: Patients were not required to provide informed consent for this study because the analysis used anonymous clinical data that were obtained after each patient had agreed to treatment with written consent.
Conflict-of-interest statement: None of the authors have any conflicts of interests to declare.
Data sharing statement: There are no additional data available in relation to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kyung Mo Kim, MD, Professor, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. kmkim@amc.seoul.kr
Telephone: +82-2-30103380 Fax: +82-2-4733725
Received: November 10, 2017
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
Abstract
AIM

To evaluate the use of fully covered self-expandable metal stents (FCSEMSs) for pancreatic duct strictures in children with chronic pancreatitis.

METHODS

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.

RESULTS

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).

CONCLUSION

This initial experience showed that temporary FCSEMS placement is feasible and safe for the management of refractory benign MPD stricture in children.

Keywords: Chronic pancreatitis, Pancreatic duct, Self-expandable metal stent, Child, Endoscopic retrograde cholangiopancreatography

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.