Endoscopic treatment of intraductal pancreatic stent fragmentation.

ABSTRACT

BACKGROUND AND AIM: Complications of endoscopic treatment are reported more and more often as a result of popularization of pancreatic endotherapy. Our study presents the results of treatment in patients with intraductal pancreatic stent fragmentation diagnosed during endotherapy of chronic pancreatitis. METHODS: Retrospective analysis of 2496 endoscopic retrograde cholangiopancreatography procedures which were carried out in 607 patients at the Gastrointestinal Endoscopy Unit of the University Clinical Center in Gdansk. RESULTS: In the course of pancreatic endotherapy, intraductal pancreatic stent fragmentation was stated during 33 of 2496 (0.013%) procedures in 33 of 607 (5.44%) patients with chronic pancreatitis. In 33 patients, there were 46 intraductal fragments of broken stents. Most patients were asymptomatic. In 31/33 patients, fragments of broken stents were removed from the pancreatic duct endoscopically. In the case of two patients, endoscopic management was ineffective and they were treated surgically. Altogether, 44/46 stent fragments were removed endoscopically. Most fragments of pancreatic stents were removed during the first endoscopic procedure. One fragment of a broken stent was retrieved with polypectomy snare and four with Dormia basket. The remaining fragments of broken pancreatic stents were removed with rat-tooth forceps. CONCLUSIONS: Intraductal fragmentation of pancreatic stent is a rare complication of pancreatic endotherapy and it often has an asymptomatic course. Most fragments of broken pancreatic stents can be removed endoscopically from the pancreatic duct with an acceptable complication rate.