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Tips and Cautions in Pancreatic Stent implantation
How does the guide wire pass the stricture?
Even the softest guide wire could be stiff when it enters pancreatic duct. It is possible to have perforation or form false passage in pancreatic duct.
If the passing way of stricture in the pancreatic duct could not be seen clearly, inject contrast medium to judge the stricture direction and angle. Use the balloon catheter. It may facilitate the guide wire in entering the stricture. For malignant stricture, guide wire with soft and curved tip could enter more easily. For benign stricture, guide wire with curved tip and normal stiffness is more suitable. Please do not use Soehandra without a guide wire.
How to choose pancreatic plastic stent?
According to our research, linear shape plastic stent is comparably easier to deploy and it has better drainage effect than pigtail stent. The most commonly used stent is linear shape with single wing at both ends.
Choose correct stent length. Generally, the proximal wing protrudes beyond the stricture 1cm, the distal wing is on the level of duodenal papilla. The end of the tube could not protrude from the papilla too much. This is to avoid the injury on the duodenal mucosa. The effective length of the stent is the length from proximal end of the stricture to the papilla. Under X –ray, measure the length from the proximal end of stricture to the endoscope front tip.
How to implant stent of diameter larger than 10 Fr?
Stent of diameter larger than 10 Fr has better drainage effect accompanied with more operational difficulties. Choose duodenal scope with endoscopic cavity 4.2mm and above. The stricture should be dilated before the stent implantation. Progressive dilation is required. Please use guide wire, guiding catheter and stent introducer in the process of stent implantation.
Information from---- Gastrointestinal Stent, Nanjing Jiangsu Scientific and Technology Press