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OC-077 The international cooperative study evaluating the effect of fully covered self-expanding metallic stents compared with plastic stents for resolution of pancreatic ductal strictures and pain relief in patients with chronic pancreatitis
  1. N Phillips1,
  2. A Siddiqui2,
  3. C Wadsworth1,
  4. P Vlavianos1,
  5. D Diehl3,
  6. T Kowalski2,
  7. D Loren2,
  8. R Sharaiha4,
  9. D Westaby1
  1. 1Hammersmith Hospital Imperial, London, UK
  2. 2Thomas Jefferson University, Philadephia
  3. 3Geisinger Medical Centre, Danville
  4. 4Weill Cornell Medicine, New York, USA

Abstract

Introduction Endoscopic placement of plastic stents (PS) is first-line therapy for pancreatic duct strictures in patients with chronic pancreatitis. Fully covered, self-expandable metal stents (cSEMS) offers an alternative to plastic stents for stricture resolution.

Method Patients at 6 tertiary centres with a dominant stricture in the pancreatic head and abdominal pain who underwent an ERCP were divided into 2 groups: 1) those that underwent PS placement and 2) those that underwent cSEMS placement. Technical success (successful stent placement), stricture resolution rate, pain reduction, and AEs were evaluated in both groups.

Results A total of 185 patients between 2011 and 2016 were included: 93 underwent cSEMS placement and 92 had PS placed. The etiologies of chronic pancreatitis were predominantly due to alcohol (55%). All patients in the cSEMS and 77% in the PS groups had daily opioid use for pain control. 57% patients in the cSEMS group had failed previous endotherapy with PS. There were no significant differences in cSEMS and PS groups with regards to technical success (99% vs. 100%) or overall procedural AEs (8.6% vs. 5.4%; p=0.4). Post-ERCP pancreatitis was 4% with cSEMS and 3.2% with PS (p=1). Stricture resolution was achieved in 86% patients with cSEMS and in 55.4% patients with PS (OR 4.95; p<0.001). The median number of ERCPs to obtain stricture resolution was lower with cSEMS: 1.5 vs. 3.9 (p=0.002). Of those who achieved stricture resolution, 27% patients in the cSEMS group and 40% in the plastic stent group developed symptomatic stricture recurrence (p=0.06). A significantly lower number of patients in the cSEMS group were referred for surgical therapy as compared to the PS group (14% vs. 28%; p=0.02). A higher number of patients in the cSEMS group were able to decrease their opioid dosage as compared to the PS group (62% vs. 51%; p=0.14). On multivariate analysis, use of cSEMS was an independent predictor of pancreatic stricture resolution (OR 2.58; p=0.05).

Conclusion cSEMS are associated with improved resolution of dominant pancreatic duct strictures in the pancreatic head/neck with fewer endoscopic sessions when compared with plastic stents. A greater number of patients with cSEMS were able to decrease their opioid dosage as compared to the PS group.

Disclosure of Interest None Declared

  • abdominal pain
  • Chronic pancreatitis
  • SEMS insertion
  • stent
  • Stricture

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