Effect of internal pancreatic duct stent on reducing long-term pancreaticojejunostomy stenosis following pancreaticoduodenectomy.

Background: As survival following PD improved, long-term complications have emerged as an issue in current era. Pancreaticojejunostomy stenosis is the common long-term sequel after PD but rarely addressed. This study aimed to investigate the benefit of pancreatic duct stent in reducing PJ stenosis after PD.

Methods: Between July 2006 and July 2019, patients undergoing PD with follow-up more than 1 year were recruited. Patients were divided into internal stent, external stent, and no stent groups. We reviewed the Computed tomography (CT) to measure the diameter of pancreatic duct and stent migration at 3 months and 1 year after PD. PJ stenosis was defined as pancreatic duct diameter > 3 mm. Perioperative variables were collected for analysis.

Results: Totally, 506 patients were included 349 patients in internal stent group, 84 patients in the external stent, and 73 patients in no stent group. There was no difference in preoperative P-duct size between the IS and ES group (3.39 ± 1.78 mm vs 3.26 ± 1.89 mm, p = 0.481), while the P-duct size was larger in ES group compared to the IS group (3.22 ± 2.44 mm vs. 1.94 ± 2.08 mm, p < 0.001) one year after PD. In the internal stent group, the rate of stent migration was 22.1% at 3 months and 67.9% at 1 year post-operatively. CR-POPF (OR 2.24, p = 0.015) and P-duct stent retention at PJ > 3 months (OR 0.45, p < 0.001) were the independent factors for 1-year PJ stenosis in multivariate analysis.

Conclusion: Retention of internal pancreatic duct stents at the anastomosis for more than 3 months can reduce post-PD PJ stenosis. Extended retention of internal pancreatic duct stents reduces PJ stenosis, highlighting its critical role in preventing long-term complications.