One in Two Children with Chronic Pancreatitis Experience Stent Migration, Leading to Repeated Hospital Procedures During Critical Growth and School Years

Asan Medical Center Researchers Evaluate ERCP Treatment Using a Novel Winged Anti Migration Stent

Zero Stent Migration and 90% Treatment Success Rate, Reducing Repeat Procedures and Improving Quality of Life

▲ (From left) Professors Do Hyun Park and Gunn Huh of the Division of Gastroenterology, and Professor Kyung Mo Kim of the Pediatric Gastroenterology and Nutrition at Asan Medical Center, together with Professor Yun Je Song of the Division of Gastroenterology at Dankook University Hospital.

In children with recurrent pancreatitis, narrowing of the pancreatic duct caused by repeated inflammation can lead to severe abdominal pain, requiring treatment. Endoscopic therapy is commonly performed to widen the narrowed duct by placing a stent. However, because the pancreatic duct is narrower and shorter in children than in adults, the stent frequently migrates from its original position.

Now, researchers in Korea have reported that a novel anti migration stent can safely and effectively treat children with chronic pancreatitis, offering a promising solution to this long-standing challenge.

A research team led by Professors Do Hyun Park and Gunn Huh of the Division of Gastroenterology at Asan Medical Center, together with Professor Yun Je Song of the Division of Gastroenterology at Dankook University Hospital and Professor Kyung Mo Kim of the Pediatric Gastroenterology and Nutrition at Asan Medical Center, evaluated the outcomes of treating pancreatic duct strictures in patients with chronic pancreatitis using a metal stent equipped with fixation wings at both ends to prevent migration. The study found that no cases of stent migration occurred among pediatric patients, while the treatment achieved a success rate of 90.3%.

By comparing the outcomes with those of adult procedures, the researchers also demonstrated that the anti migration metal stent, whose effectiveness has already been established in adults, is equally safe and effective for treating pediatric patients.

Chronic pancreatitis is a condition in which repeated inflammation progressively damages the pancreas. Over time, it can impair both the production of digestive enzymes and the regulation of blood glucose levels, while causing severe abdominal pain that significantly reduces quality of life.

A particularly challenging complication is main pancreatic duct stricture, a narrowing of the main pancreatic duct through which pancreatic fluid flows. The resulting increase in ductal pressure can trigger recurrent abdominal pain and repeated episodes of pancreatitis. To relieve the obstruction, physicians perform endoscopic retrograde cholangiopancreatography (ERCP), an endoscopic procedure in which a stent is placed in the narrowed pancreatic duct to restore the normal flow of pancreatic fluid.

Plastic stents are commonly used during ERCP in pediatric patients. However, because of their small diameter, they can become obstructed after placement, preventing adequate drainage of pancreatic fluid. In addition, if the stent migrates from its original position, repeat endoscopic intervention is required. Previous studies have reported that one in two pediatric patients who underwent endoscopic treatment for pancreatic duct strictures experienced stent migration.

Metal stents, by contrast, have a wider diameter than plastic stents, allowing more effective drainage of pancreatic fluid. However, they have rarely been used in children because stent migration can lead to the development of new pancreatic duct strictures, raising concerns about their safety in pediatric patients.

The research team therefore evaluated the effectiveness of ERCP using a metal stent with an anti migration design. The stent features wing shaped anchors at both ends that secure it within the pancreatic duct, preventing it from migrating after placement.

The researchers retrospectively analyzed the long-term outcomes of 31 patients aged 18 years or younger with chronic pancreatitis who underwent ERCP using the anti migration metal stent at Asan Medical Center between January 2010 and April 2025, with a median follow up of approximately seven years. The procedures were performed by pediatric specialists with careful consideration of the patients' anatomical characteristics. The stent placement success rate was 100%, and no cases of stent migration occurred during the treatment period.

The treatment achieved an overall success rate of 90.3%. Treatment success was defined as both adequate resolution of the main pancreatic duct stricture and a reduction of more than 50% in pain medication use compared with pretreatment levels. Notably, the narrowed pancreatic duct was successfully relieved in 96.8% of patients.

No major procedure-related complications were reported. One patient developed mild pancreatitis, which resolved with conservative treatment, including medication. The researchers also concluded that reducing the need for repeated endoscopic procedures through the use of the anti migration metal stent could lower overall treatment costs while easing the burden on pediatric patients and their families.

Professor Do Hyun Park of the Division of Gastroenterology at Asan Medical Center said, “Our collaborative study demonstrated that metal stents with an anti migration design can be safely maintained in the main pancreatic duct of children with chronic pancreatitis, achieving both a high stricture resolution rate and excellent clinical success. For pediatric patients who have experienced repeated stent migration or treatment failure with conventional plastic stents, this refined, pediatric tailored endoscopic approach could provide an effective treatment option.”

Professor Kyung Mo Kim of the Pediatric Gastroenterology and Nutrition at Asan Medical Center said, “Chronic pancreatitis in children is a lifelong condition that often requires repeated treatment from an early age. Building on Asan Medical Center’s experience of performing more than 1,000 pediatric ERCP procedures, a milestone achieved by only a handful of centers worldwide, we provide long-term treatment strategies that take into account not only disease management but also our patients’ growth, education, and overall quality of life. We hope this collaborative research with the Department of Gastroenterology will help reduce the treatment burden on children and their families by minimizing the need for repeated procedures and hospitalizations.”

The study was recently published in Gastrointestinal Endoscopy (Impact Factor: 8.0), the official peer reviewed journal of the American Society for Gastrointestinal Endoscopy (ASGE).