Clinical Outcome of Pancreatic Stenting in the Chronic Pancreatitis Associated with Stricture

Roe, Im Hwan; Song, Il Han; Chin, Young Joo; Kim, Jung Won; Kim, Jung Taik; Lim, Chang Young

Abstract

BACKGROUND AND AIMS: Similar to surgical drainge, endoscopic therapy for control of pain in chronic pancreatitis is aimed to alleviating obstruction of outflow caused by ductal stricture, stone or pseudocyst. We examined clinical results of pancreatic stenting in the chronic pancreatits.
METHODS
For nineteen patients with symptomatic chronic pancreatitis showing only ductal stricture and ductal stricture with stone, duct disruption, and/or pseudocyst (confirmed by endoscopic retrograde pancreato- graphy), total 32 attempts of pancreatic stenting were performed and followed up for 18 months (6-24 months). All patients were also performed pancreatic sphincterotomy. Pancreatic stents of 7 French were used at the first attempts and occasionally stents of 10 French were used in the second or third attempts. All patients were examined by ERCP at every 3 months during follow-up.
RESULTS
Pancreatogram of 19 patients with chronic pancreatitis revealed only pancreatic ductal stricture in 12 cases, ductal stricture with ductal stone in 3 cases, and ductal stricture with ductal disruption and/or pseudocyst in 4 cases. The stricture site was ductal head in 12 cases, and its body or tail in 7 cases. The number of stricture was single in 10 cases, and two or more in 9 cases. The total length of time keeping stents in the pancreatic duct was 3 to 9 months. No stent clogging except 2 cases was found at follow-up ERCP. Pain relief was observed in 89.5% (17/19 cases). Stent migration occurred in 4 cases (21.1%). and pancreatitis in 4 cases (21.1%) and the ductal morphological changes after stenting were found in 13 cases (68.4%). However, serious complications such as sepsis, perforation, or bleeding were not observed.
CONCLUSIONS
Although little is known about the longterm physiologic or histologic effect after stenting, pancreatic stenting seems to respond favorably to ductal decompression and clinical outcome as a temporary measure.