Clinical Endoscopy

Review

Role of fully covered metal stents in the management of chronic pancreatitis: Younghun Jeon, Hoonsub So, Sung Jo Bang; Received December 26, 2024 Accepted February 13, 2025 Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.349 [Epub ahead of print]

Abstract PDF PubReader ePub: Chronic pancreatitis (CP), a progressive inflammatory disease that results in irreversible pancreatic damage, is often complicated by ductal strictures and debilitating pain. Fully covered self-expandable metal stents (FCSEMS) have emerged as significant innovations in the endoscopic management of refractory pancreatic duct strictures. This review synthesizes recent evidence highlighting the benefits and limitations of FCSEMS, such as superior patency, reduced need for reinterventions, and effective symptom relief compared to traditional plastic stents, alongside risks, such as stent migration and de novo strictures. A comparison with plastic stents and an algorithm for pancreatic duct stricture management are provided. Regional variations in clinical guidelines from the United States, Europe, Japan, and Korea reflect diverse approaches to integrating FCSEMS into practice. Emerging innovations in stent technology are promising for improving CP management outcomes.

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Original Articles

Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2025;58(2):311-319. Published online August 26, 2024; DOI: https://doi.org/10.5946/ce.2024.089

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Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Citations

Citations to this article as recorded by

Transanastomotic Forward-Viewing EUS-Guided Pancreatic Duct Drainage via Afferent Loop for Pancreaticojejunostomy Anastomotic Stricture After Pancreaticoduodenectomy
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2025; 70(1): 413. CrossRef
Management of Pancreaticojejunostomy Strictures: A New Perspective with Forward-Viewing EUS
Radhika Chavan
Digestive Diseases and Sciences.2025; 70(5): 1740. CrossRef
Transforming endoscopic approaches to post-pancreaticoduodenectomy anastomotic strictures: beyond the surface
Yu-Ting Kuo
Clinical Endoscopy.2025; 58(2): 259. CrossRef
Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture
Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yutaro Saito, Shiori Koyama, Tomohiro Betto, Chika Kusano
Endoscopy.2025; 57(S 01): E384. CrossRef

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Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2024;57(5):666-674. Published online June 5, 2024; DOI: https://doi.org/10.5946/ce.2023.272

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Background
/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Citations

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Feasibility of endoscopic ultrasound‐guided hepaticogastrostomy using a novel long balloon catheter
Yuichi Takano, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Fumitaka Niiya, Naotaka Maruoka, Tatsuya Yamagami, Masatsugu Nagahama
DEN Open.2025;[Epub] CrossRef
Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook
Si-Yao Wang, Si-Qiao Zhao, Shu-Peng Wang, Yue Zhang, Si-Yu Sun, Sheng Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
Han Taek Jeong, Jimin Han
Clinical Endoscopy.2024; 57(5): 608. CrossRef
Technical outcomes between a drill dilator and ultra-tapered mechanical dilator during EUS-guided pancreaticogastrostomy: Comparative study
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa
Endoscopy International Open.2024;[Epub] CrossRef

4,177 View
324 Download
3 Web of Science
4 Crossref

Reviews

Management of Benign and Malignant Pancreatic Duct Strictures: Enad Dawod, Michel Kahaleh; Clin Endosc 2018;51(2):156-160. Published online July 20, 2017; DOI: https://doi.org/10.5946/ce.2017.085

Abstract PDF PubReader ePub

The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

Citations

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Harishankar Gopakumar, Neil R. Sharma
Frontiers in Gastroenterology.2023;[Epub] CrossRef
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Franz Rudler, Fabrice Caillol, Jean-Philippe Ratone, Christian Pesenti, Jean-Christophe Valats, Alexei Soloveyv, Marc Giovannini
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Zo C. Overton-Hennessy, A. Michael Devane, Steve Fiester, Noah Schammel, Christine Schammel, James W. Fulcher
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Long-term outcomes of fully covered self-expandable metal stents versus plastic stents in chronic pancreatitis
Sang Hoon Lee, Yeon Suk Kim, Eui Joo Kim, Hee Seung Lee, Jeong Youp Park, Seung Woo Park, Si Young Song, Jae Hee Cho, Seungmin Bang
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Pancreatology.2020; 20(6): 1045. CrossRef
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Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions: Christopher G. Chapman, Irving Waxman, Uzma D. Siddiqui; Clin Endosc 2016;49(2):161-167. Published online March 25, 2016; DOI: https://doi.org/10.5946/ce.2016.011

Abstract PDF PubReader ePub

Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD.

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