Application of Soehendra stent retriever in patients with pancreatic or bile duct stricture / 解放军医学杂志

Objective To evaluate the efficacy of Soehendra stent retriever as used as a dilator for the patients with high grade stricture of pancreatic or bile duct. Methods Forty-eight patients, who underwent endoscopic retrograde cholangiopancreatography (ERCP) from Jan. 2010 to Oct. 2012 in Endoscopy Department of General Hospital of Shenyang command, were found to have pancreatic or bile duct stricture. Dilation was then attempted using a dilating sound. Once the stricture could not be traversed, the Stent Retriever was inserted over the sound to dilate the stricture. Results A total of 554 patients were diagnosed to suffer from pancreatic or bile duct stricture with the aid of ERCP. Among them dilatation of stricture with catheter failed in 48 cases (8.7%) and Soehendra stent retriever was then used for dilatation. Of the 48 cases, ERCP revealed common bile duct stricture in 8 patients, common hepatic duct stricture in 6 patients, porta hepatis stricture in 5 patients, stricture at neck of pancreas stricture in 18, stricture at body of pancreas in 4, stoma stricture after liver transplant in 4, and occlusion of metallic stent in 3 patients. For these cases, Soehendra stent retriever was used to dilate the stricture prior to setting stent or endoscopic nasobiliary drainage (ENBD) with a success rate of 100%. No related complication was found. Conclusion Pancreatic and bile duct stricture can be dilated successfully with the Soehendra stent retriever. The procedure is of low risk and highly effective.

Endoscopic Approach via the Minor Papilla for the Treatment of Pancreatic Stones

BACKGROUND/AIMS: We aimed to evaluate whether the advanced techniques have influenced the minor papilla approach. METHODS: We studied the success rate of guide wire insertion by using ordinary techniques and advanced techniques (rendezvous method and precut method) in 30 patients via the minor papilla. We compared the selection of the access routes between before (52 patients) and after (28 patients) the introduction of the Soehendra stent retriever. RESULTS: In 19 out of 30 patients (63%), guide wire insertion via the minor papilla could be achieved by using ordinary techniques. In total, the guide wire could be inserted in 27 patients (90%) by using the advanced techniques. Before introduction of the Soehendra stent retriever, the major papilla approach was chosen in 38 cases (73%), and the minor papilla approach in 14 cases (27%). After introduction of the Soehendra stent retriever, the major papilla approach was used in 26 cases (93%) and the minor papilla in 2 cases (7%). The frequency of selecting the minor papilla approach has significantly decreased (p<0.05). CONCLUSIONS: The advanced techniques have contributed to the improvement of endoscopic approaches via the minor papilla, and decreased the frequency of selecting the minor papilla approach.

The Clinical Efficacy of Uisng a Soehendra Stent Retriever for Endoscopic Biliary Drainage in Malignant Biliary Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic biliary drainage is widely used for the palliative treatment of malignant biliary obstruction. For the advanced stricture, the general treatments such as a dilating or balloon catheter can not fully expand a duct. The authors used a Soehendra Stent Retriever for these cases, and we evaluated the value of using this instrument for treating these patients. METHODS: From July 2006 to Jun 2008, we studied 12 patients with mailignant biliary obstruction (Klatskin's tumor=10, Gall bladder cancer=2) and who were failed at having a stent inserted with such general treatment such as using a dilating or balloon catheter (M: F=7:5, age=69.1 years old). For the bilateral biliary drainage of the duct, the "stent in stent" method was used and 12 patients were treated with a Soehendra Stent Retriever with clockwise rotation, as well as going forward to expand the target area of the intrahepatic bile duct obstruction and insert a metal stent. RESULTS: Ten patients among the 12 who were treated by a Soehendra Stent Retriever achieved successful insertion of a stent (technical success, 83.3%), and all 12 patients showed improvement of their jaundice. CONCLUSIONS: To insert bilateral stents for the advanced malignant biliary obstruction, expanding the strictured area with a Soehendra Stent Retriever can improve the success of inserting a stent.

Dilatation of Narrowed Pancreatic Duct Using a Soehendra Stent Retriever in Chronic Pancreatitis Patients / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic pancreatic ductal drainage may help alleviate the pain from chronic pancreatitis, but stricture dilatation may be technically difficult. Dilatation of high grade strictures of the pancreatic ducts with using dilating or balloon catheters may result in failure. We evaluated the efficacy of using the Soehendra stent retriever as a dilator. METHODS: Fourteen patients with pancreatic stricture had dilation performed with a Soehendra stent retriever. Each patient had sphincterotomy, guidewire placement and stent retriever dilatation. RESULTS: All procedures were successful and none of the patients had complications. Symptom relief was observed after dilation in all patients. There was no complication associated with the use of the stent retriever. None of the patients have relapsed for 6 months. CONCLUSIONS: The Soehendra stent retriever is safe and effective as a dilating device for the pancreatic strictures that are resistant to conventional dilation.

Endoscopic Biliary Drainage Using Soehendra Stent Retriever in Difficult Malignant Biliary Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. METHODS: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. RESULTS: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. CONCLUSIONS: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture.