Stenting Versus Non-Stenting in Pancreaticojejunostomy A Prospective Study Limited to a Normal Pancreas Without Fibrosis Sorted by Using Dynamic MRI

Objectives: We prospectively investigated the efficacy of an external pancreatic duct stent to prevent pancreatic fistula in the nonfibrotic pancreas after pancreaticojejunostomy, in which the degree of pancreatic fibrosis was assessed objectively by using dynamic magnetic resonance imaging (MRI). Methods: Among the 67 consecutive patients who underwent pancreatic head resection, 45 patients were judged to have a normal pancreas without fibrosis based on the preoperative assessment of pancreatic fibrosis based on MRI. The patients were randomly allocated to 1 of 2 groups with (n = 23) or without (n = 22) use of an external pancreatic duct stent in performing a pancreaticojejunostomy. Results: Pancreatic fistula developed in 8 (34.5%) patients in the stented group: 3 grade A and 5 grade B; whereas in the nonstented group, 9 (40.9%) patients developed pancreatic fistula: 3 grade A and 6 grade B. There were no significant differences in the incidence or severity of pancreatic fistula between the 2 groups. Conclusions: The utility of the external pancreatic duct stent after pancreaticojejunostomy was not found in the nonfibrotic pancreases, which were sorted according to the degree of pancreatic fibrosis using the pancreatic time-signal intensity curve analysis from MRI.