Endoscopic transpapillary pancreatic duct stent placement in patients with necrotizing pancreatitis

Aim. Improvement of treatment results in patients with necrotizing pancreatitis and signs of the dissociation between the distal and proximal parts of the pancreas by using endoscopic transpapillary stent placement.

Material and methods. There were 25 patients with acute necrotizing pancreatitis and disconnected pancreatic duct syndrome, which have been managed by using endoscopic transpapillary stent placement throughout 2018-2020. Twenty patients have been admitted into hospital in first 24-72 hours of onset, while 5 patients – later than 72 hours. We have diagnosed necrotizing process located in the head and the neck of the pancreas and peripancreatic space in all these patients (“Model III”).

Results. Positive results related to transpapillary stent placement were noted in 18 patients (72% – main group). Sixteen patients from this group were admitted into hospital in first 24–72 hours, two patients – later than 72 hours from the disease onset. Transpapillary stent placement failed in 7 (28%) patients (control group). Complications in the main group occurred in 2 patients (11,1%): in one case – the dislocation of stent into duodenum and one patient with bleeding after papillosphincterotomy, infected necrotized pancreatitis developed in 4 patients. Mortality observed in 1 case (5.5%).

Complications among control group occurred in 2 patients (28.6) – arrosive bleeding, infected necrotized pancreatitis developed in 3 patients. Mortality observed in 1 case (14.3%).

Conclusions. Endoscopic transpapillary stent placement is an effective minimally invasive approach in management of patients with necrotizing pancreatitis.

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