Endoscopic ductal drainage may avoid resective surgery in painful chronic pancreatitis without large ductal dilatation

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Abstract

Conclusion.

Endoscopic stenting treatment, in cases of chronic pancreatitis unsuitable for decompressive surgery, appears to be safe and efficient. Perfect anatomical results are only obtained if large stents are used after balloon dilatation.

Background.

Decompressive surgery in cases of painful chronic pancreatitis is only feasible if the main pancreatic duct exceeds approx 8 mm over a sufficient length. When those anatomical changes are not present, surgery must be resective. This study evaluates the results of endoscopic stent drainage and decompression of painful chronic pancreatitis without large dilatation of the main pancreatic duct.

Methods.

Sixteen of our chronic pancreatitis patients were included in this study. They presented a mean of 5.3 episodes of pain in the 6 mo before treatment. Decompressive surgery was not possible because of a mean pancreatic duct diameter of 5.8 mm. Stents were 7F in eight patients and 12F in the other eight. They were left in the duct after endoscopic dilation for 9.5±1.0 mo.

Results.

During stenting we observed two early obstructions and seven episodes of pain. All cysts disappeared and stenosis of the duct disappeared anatomically in six cases, was improved in four, but persisted in six. During follow-up, two episodes of mild pain were recorded. No cysts reappeared. Complete disappearance of stenosis was only observed in patients whose pancreatic duct was equipped with a 12F stent (P<0.02).

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