Elsevier

Gastrointestinal Endoscopy

Volume 42, Issue 5, November 1995, Pages 461-467
Gastrointestinal Endoscopy

Long-term results of pancreatic stents in chronic pancreatitis,☆☆,

https://doi.org/10.1016/S0016-5107(95)70051-XGet rights and content

Abstract

Background: Pancreatic stenting is a new nonsurgical treatment for patients with chronic pancreatitis and pain. We studied the long-term safety and efficacy of pancreatic stenting.

Methods: Between 1982 and 1993, 51 patients with chronic pancreatitis and persistent pain with dominant strictures in the pancreatic duct were treated with plastic pancreatic stents.

Results: Stent insertion was successful in 49 of the 51 patients. Early complications occurred in 9 of the 51 patients (18%). Patients were followed for a median of 34 months (range 6 to 128). Nine of the 49 patients had no clinical improvement and stents were removed. Forty of the 49 patients (82%) had clinical improvement. Sixteen of these 40 patients still had their stents in place. Stents were removed in 22 of the 40 patients with persistent beneficial response in all (median follow-up 28.5 months). The long-term effect of stenting could not be evaluated in the remaining 2 patients because they had a double bypass operation. Stent dysfunction occurred in 27 of the 49 patients (55%) and was successfully treated by exchanging the stent.

Conclusions: Pancreatic stenting was associated with minimal early complications, but stent dysfunction remained a frequent late complication. Pancreatic drainage resulted in clinical improvement in 40 of the 49 patients (82%). Twenty-two of these 40 patients maintained the beneficial response after stent removal (28.5 months). (Gastrointest Endosc 1995;42:461-7.)

Section snippets

PATIENTS AND METHODS

In this retrospective study, we included all patients with (1) chronic pancreatitis and persistent pain, (2) dominant strictures and proximal dilation of the pancreatic duct, and (3) an attempt to insert a pancreatic stent between 1982 and 1993. Approximately 19,000 ERCPs were performed during this interval.

The total number of patients was 51 (35 men and 16 women with a median age of 45 years [range 8 to 78 years]). Patients were diagnosed with chronic pancreatitis for a period ranging between

Evaluation and follow-up

The median period of follow-up after stent insertion in the period between 1982 and 1993 was 34 months (range 6 to 128). Fig. 3 shows the clinical outcome and follow-up of pancreatic stenting in 49 patients.

. Clinical outcome and follow-up in 49 patients with chronic pancreatitis, pancreatic main duct strictures, and persistent pain.

During stenting, 40 of the 49 patients had clinical improvement. Of these 40 patients, 20 were completely asymptomatic. Nine of the 49 patients had no clinical

DISCUSSION

Patients with chronic pancreatitis and pain are usually treated with analgesics, oral pancreatic enzyme therapy, abstinence from alcohol, a low-fat diet, and small-volume meals, but these measures are often only partially successful in relieving pain. Enthusiasm for the application of pancreatic drainage procedures should be tempered by the knowledge that the cause of pain in patients with chronic pancreatitis may be multifactorial. Some investigators have advocated avoiding invasive measures

Acknowledgements

The authors thank Mrs. G.E.E. van Noppen.

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From the Academic Medical Center, University of Amsterdam, Department of Gastroenterology, Amsterdam, The Netherlands.

☆☆

Reprint requests: Marianne E. Smits, MD, Gastroenterology, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands.

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