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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

b_petersen(1)

Biography

Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.

Disclosures

Consultant 

Boston Scientific 

Advisory Board 

Ethicon/J & J

 

Summaries

Removable SEMS in the Main Pancreatic Duct for Treatment of Chronic Pancreatitis

Bret T. Petersen, MD, FASGE reviewing Tringali A, et al. Gastrointest Endosc 2018 Aug 22.

Endoscopic therapy of symptomatic pancreatic duct strictures requires serial procedures for placement and upsizing of plastic stents over many months, yielding only moderate benefits. This study investigated 6 months of treatment of main duct strictures with covered self-expandable metal stents (FCSEMS) among 15 patients with pancreatic head strictures and persisting pain after three months of single stent therapy. Outcomes included removability of the FCSEMS, stricture resolution, and adverse events. Pancreatic calcifications were present in 40%, alcohol abuse in 27%. Ten patients were treated through the major papilla and five through the minor papilla. One patient developed cholangitis from stent-related obstruction of the bile duct, 7 with short (3 cm) stents exhibited complete stent migration from the duct, two of which experienced symptomatic pancreatitis and five that were asymptomatic. Long term, 1 patient was lost to follow-up, 1 had stricture(s) which failed to resolve and 4 were excluded because of new stent-induced strictures. Among 9 patients with stricture resolution, 89% were asymptomatic at a mean of 38.9 months (range, 5.3-55.3 months).


Comment:

Endoscopic therapy is moderately successful but not typically as durable as surgery, which carries greater morbidity in the short term. Placement of FCSEMS in the pancreatic duct has been considered contraindicated because of the likelihood of side branch obstruction, but they may facilitate more rapid stricture dilation, require fewer procedures and might be associated with better outcomes. The present study had significant dropout, largely because of strictures at the flared inner end of the stents. Future alterations in stent design may lead to large-caliber stents that are effective in treating pancreatic duct strictures while avoiding stent-induced new stricture formation, which was a major limitation of FCSEMS in this study.

Note to readers:
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):
Tringali A, Vadalả di Prampero SF, Landi R, et al. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc 2018 Aug 22. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2018.08.019)