A pancreatic duct stent is a small, thin tube placed into the pancreatic duct, a passageway that carries digestive fluids from the pancreas to the small intestine. Its primary function is to maintain an open channel, allowing pancreatic fluids to drain properly. This drainage helps prevent blockages and complications like inflammation of the pancreas, known as pancreatitis. The stent acts as a temporary or sometimes longer-term bypass, supporting the natural flow of these important digestive juices.
Medical Reasons for a Pancreatic Stent
Pancreatic duct stents are used to address several conditions that disrupt the normal flow of pancreatic fluid. These medical interventions aim to relieve obstruction, facilitate healing, or prevent complications arising from pancreatic disorders.
Pancreatic Duct Strictures
Chronic pancreatitis or scarring can cause the pancreatic duct to narrow, a condition known as a stricture. This narrowing impedes the flow of pancreatic fluids, leading to pain and further inflammation. A stent is placed to hold the narrowed duct open, restoring proper drainage and reducing symptoms. Plastic stents are often used as an endoscopic treatment for these strictures, sometimes for a fixed duration or exchanged if symptoms return.
Pancreatic Duct Leaks
Leaks from the pancreatic duct can occur following injury, surgery, or severe episodes of pancreatitis. When the duct is disrupted, pancreatic fluid can escape into surrounding tissues, forming collections or fistulas. A stent is positioned to bridge the damaged area, diverting the fluid into the digestive tract, allowing the leak to heal. This relieves pressure from the leakage site and guides the flow of pancreatic secretions into the duodenum.
Preventing Post-ERCP Pancreatitis (PEP)
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that can sometimes lead to inflammation of the pancreas afterward. For certain patients at elevated risk, a temporary stent is placed into the pancreatic duct following an ERCP to reduce this complication. The stent helps ensure continuous drainage of pancreatic secretions, even if the duct opening swells due to the procedure. Prophylactic stent insertion has shown to reduce the rate of PEP, especially after inadvertent cannulation of the pancreatic duct during ERCP.
Draining Pancreatic Fluid Collections (Pseudocysts)
Pancreatic pseudocysts are collections of fluid that can form as a complication of pancreatitis. When these pseudocysts cause symptoms or become infected, a stent can be used to create a drainage pathway. This stent connects the pseudocyst directly to an adjacent part of the digestive tract, such as the stomach or small intestine, allowing the fluid to drain. Endoscopic ultrasound (EUS) often guides this placement, particularly for larger or more complex collections.
The Stent Placement Procedure
The placement of a pancreatic duct stent typically involves a specialized endoscopic procedure called Endoscopic Retrograde Cholangiopancreatography, or ERCP. This procedure allows a gastroenterologist to access the pancreatic duct without open surgery.
Before the procedure, patients are asked to fast for several hours. Sedation or anesthesia is administered to keep the patient comfortable. This allows the medical team to perform the procedure safely.
An endoscope, a long, flexible tube with a camera and light, is guided through the patient’s mouth, down the esophagus, and into the stomach. It then advances into the duodenum, the first part of the small intestine, where the pancreatic duct opening is located. The doctor locates this opening, called the papilla.
Once the opening is identified, a thin guidewire is inserted through the endoscope and advanced into the pancreatic duct. This wire acts as a rail, over which the stent is threaded and positioned within the narrowed or leaking section of the duct. Contrast dye may be injected to visualize the duct and confirm stent placement using X-ray imaging.
Life After Stent Placement
Following pancreatic stent placement, patients enter a recovery phase requiring monitoring and specific care instructions. Understanding what to expect and how to manage daily life with the stent can aid in a smoother recovery.
Immediately after the ERCP, patients are moved to a recovery area for a few hours while sedation wears off. A sore throat for a day or two, along with some abdominal pain or a bloated sensation, is common and usually subsides within a few hours. Patients are advised not to drive for the remainder of the day due to lingering medication effects.
Dietary adjustments are recommended to reduce strain on the pancreas and aid digestion. Initially, a clear liquid diet is advised for the first 6 to 12 hours after the procedure. If tolerated, patients can gradually transition to soft, bland foods, such as mashed potatoes or oatmeal, within 24 hours. A low-fat diet is encouraged, along with eating smaller, more frequent meals to reduce the workload on the digestive system.
Patients should monitor for any concerning symptoms and contact their healthcare provider if they occur. These warning signs include severe or worsening abdominal pain, persistent nausea or vomiting, fever, chills, or jaundice (yellowing of the skin or eyes). Prompt reporting ensures timely evaluation and management of any potential issues.
Stent Removal and Follow-Up
Most pancreatic stents are temporary, particularly plastic ones, and require planned removal or exchange to prevent complications like clogging or migration. Plastic stents typically remain in place for 3 to 6 months. Metal stents, conversely, may be designed for longer or even permanent use in certain situations.
Pancreatic stent removal is performed during another endoscopic procedure, often a simpler ERCP, once its purpose has been served or if complications arise. During this procedure, the endoscope is used to grasp and withdraw the stent from the pancreatic duct. The process is less involved than the initial placement, as the duct has already been dilated.
Attending scheduled follow-up appointments for stent removal is important to avoid potential problems. Leaving a temporary stent in place for too long can lead to blockages, infection, or damage to the pancreatic duct. Regular monitoring and timely removal help ensure a good long-term outcome for the patient.