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ROLE OF ENDOSCOPIC STENTING FOR BILIARY STRICTURES IN CHRONIC PANCREATITIS
Author(s) -
CRAIG PHILIP I
Publication year - 2012
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2012.01283.x
Subject(s) - medicine , pancreatitis , stent , biliary stent , endoscopic stenting , stenosis , radiology , surgery
Aim: To review the published work concerning the role of biliary stenting for chronic pancreatitis‐related strictures. Methods: A case study in which multiple plastic stents are used to manage a chronic pancreatitis biliary stricture is presented, and the published work reviewed. Results: There has been a gradual evolution in the endoscopic management of distal biliary strictures secondary to chronic pancreatitis. Most early series used single (usually 10 F) plastic stents for varying time periods. Long‐term stricture resolution occurred in only approximately 25% of patients and stent‐related complications were high if stent exchanges were not performed routinely every 3–4 months. Recent studies using multiple (≥3) 10 F stents placed sequentially every few months for approximately 12 months have resulted in resolution of biliary strictures in up to 90% of patients. In general, the use of both uncovered and partially covered self‐expandable metal stents for biliary strictures due to chronic pancreatitis have been disappointing due to problems with epithelial hyperplasia involving the uncovered portions of the self‐expandable metal stents resulting in late stent occlusion and other problems. Similarly, early published data does not at this stage support the routine use of fully covered self‐expandable metal stents because of unacceptable stent‐related complications. Conclusion: Chronic pancreatitis‐related biliary strictures should be managed initially with sequentially‐placed multiple 10 F plastic stents for approximately 12 months.