Placement of duodenal stents across the duodenal papilla may predispose to acute pancreatitis: a retrospective analysis

Abstract

PURPOSE: To evaluate retrospectively the incidence, predictive factors, and management of acute pancreatitis which develops following placement of duodenal stents in patients with malignant gastroduodenal obstruction. MATERIALS AND METHODS: Among 242 patients with symptomatic malignant gastroduodenal obstruction successfully treated with duodenal stent placement, acute pancreatitis occurred in 10 patients (4.1%) at 1-7 days after stent placement. Univariate and multivariate analyses were performed to evaluate factors predictive of acute pancreatitis. Management of acute pancreatitis was also evaluated. RESULTS: Ten patients with acute pancreatitis presented with abdominal pain and distention with vomiting at 1-7 days after stent placement, and seven patients developed acute jaundice. Pancreatitis resolved in four patients with a regime of fasting and intravenous nutrition. The remaining six cases were managed with percutaneous transhepatic cholangiography and drain (PTCD) placement. Univariate analysis showed that acute pancreatitis was associated with stent location in the descending duodenum (P = 0.001) and with stents bridging the duodenal papilla (P < 0.001). Multivariate analysis demonstrated that the presence of a stent bridging the duodenal papilla (odds ratio, 18.48; 95% confidence interval, 2.298- 148.48; P = 0.006) was an independent predictor of acute pancreatitis. CONCLUSION: Acute pancreatitis is an uncommon early complication of duodenal stent placement in patients with malignant gastroduodenal obstruction. In this group of patients, acute pancreatitis was associated with stent location in the descending duodenum and occurred in patients with stents bridging the duodenal papilla; the latter may be the most important predictor of acute pancreatitis. Jaundice can be managed conservatively or with PTCD.