Trattamento endoscopico di pazienti con stenosi sintomatica del coledoco in corso di pancreatite cronica con l'utilizzo di protesi metallica parzialmente ricoperta : studio pilota

Background and study aims. While surgery remains the gold standard for the treatment of symptomatic common bile duct stenosis associated with chronic pancreatitis, plastic and self-expandable open mesh stents have been proposed as alternative treatments but are associated with dysfunction mainly due to stent occlusion by clogging or inflammatory tissue hyperplasia. The aim of this study was to evaluate safety and long-term results of partially covered metal stenting in this setting. Patients and methods. Fourteen patients (12 men, 50?3 years) underwent partially covered metal stent insertion for common bile duct stenosis secondary to chronic pancreatitis (12 alcohol-related, 2 idiopathic) previously treated with plastic prostheses. Results. A 40 mm (n=13) or 60 mm (n=1) partially covered metal stent was placed depending on the length of the common bile duct stenosis and the level of the cystic duct bifurcation. Partially covered metal stent placement was technically successful in all but one case. Cholangitis resolved and cholestasis improved in all. During follow-up (median 22 months, range 12-33) seven patients developed dysfunction of the stent and required re-treatment. At 12, 24, and 30 months, the stent patency rate was 100, 40, and 37.5%, respectively. Conclusions. While partially covered metal stenting is safe and effective for immediate treatment of chronic pancreatitis associated common bile duct stenosis and had promising short term results, long-term data show that dysfunction occurs in 50% of cases. In light of the continued interest in non-surgical treatment of this condition, further research is warranted investigating new stent designs for improved long-term patency.