A pancreatic stent is a small, hollow tube designed to keep the pancreatic duct open, allowing digestive fluids to flow freely from the pancreas into the small intestine. The primary purpose of a pancreatic stent is to ensure proper drainage and prevent complications that can arise from blockages or narrowing within the duct system.
Medical Reasons for a Pancreatic Stent
Pancreatic stents address conditions that disrupt the normal flow of pancreatic fluids. One common indication is pancreatic duct strictures, which are narrowings of the duct. These strictures can result from inflammation, scarring due to chronic pancreatitis, or the presence of stones. A stent helps to prop the narrowed duct open, restoring patency and relieving associated pain.
Sometimes, a temporary pancreatic stent is placed during an endoscopic retrograde cholangiopancreatography (ERCP) procedure to reduce the likelihood of post-ERCP pancreatitis, an inflammation of the pancreas.
Pancreatic fluid collections, such as pseudocysts, also commonly require stent placement. Stents create an internal drainage pathway, allowing these fluid accumulations to drain into the stomach or small intestine, thereby alleviating symptoms and reducing the size of the collection. Additionally, stents can be used to bypass other obstructions within the pancreatic or bile ducts, including those caused by gallstones or tumors, which can impede the flow of digestive fluids and cause jaundice.
The Placement Procedure
The standard method for placing a pancreatic stent is Endoscopic Retrograde Cholangiopancreatography (ERCP). This technique uses a long, flexible tube with a camera and light, called an endoscope. The endoscope is guided through the patient’s mouth, down the esophagus, past the stomach, and into the duodenum, the first part of the small intestine.
Once the endoscope reaches the opening of the pancreatic duct, a guidewire is advanced into the duct, often past any narrowing or blockage. The stent is then threaded over this guidewire and positioned within the duct. The procedure is considered minimally invasive, as it does not involve external incisions or stitches.
Patients undergoing an ERCP receive sedation or anesthesia for comfort. This helps minimize discomfort, gagging, or coughing, allowing the procedure to be performed effectively. The duration of an ERCP can vary, but it often takes between 30 to 60 minutes.
Life After Stent Placement
After pancreatic stent placement, patients enter a recovery area as sedation subsides. Mild bloating, abdominal discomfort, and occasionally a sore throat are common, generally improving within a few hours or a day. Some individuals are discharged the same day; others might stay overnight for observation.
Dietary adjustments are recommended to support healing and prevent stent-related issues. Initially, a clear liquid diet may be advised for the first 6 to 12 hours. As tolerance improves, a gradual transition to a soft, bland, and low-fat diet is encouraged within 24 hours. Patients are advised to eat smaller, more frequent meals, chew food thoroughly, and avoid tough, fibrous, or highly processed foods that could potentially block the stent.
Patients should be aware of symptoms signaling complications, such as stent blockage, migration, or infection. These signs include worsening abdominal pain, fever, chills, or the return of jaundice (yellowing of the skin or eyes). Prompt medical attention is necessary if these symptoms arise.
Stent Duration and Removal
The length of time a pancreatic stent remains in place depends on the stent type and the medical condition it addresses. Plastic stents are temporary, typically removed or exchanged within 3 to 6 months. They can become clogged with pancreatic secretions over time, requiring removal to prevent complications like infection or recurrent blockage.
Metal stents may be used for longer-term placement, sometimes up to two years, particularly in cases where extended drainage is anticipated, such as in certain malignant obstructions. Their larger diameter allows for longer patency compared to plastic stents. The decision on stent type is often based on the patient’s prognosis and the reason for placement.
Removing a temporary pancreatic stent usually involves another ERCP procedure, similar to its initial placement. The endoscope is reinserted, and specialized tools, such as forceps, snares, or balloons, are used to grasp and withdraw the stent. Scheduled exchanges or removals are standard to maintain drainage effectiveness and minimize complications.