Pancreatic endoscopy is useful for the pain of chronic pancreatitis: PANCREATIC DUCTAL STRICTURES

PANCREATIC DUCTAL STRICTURESStrictures of the main pancreatic duct frequently occur in cases of chronic pancreatitis. While it is difficult to determine whether a particular stricture is the cause of pain, the most common endoscopic approach has been to treat patients who have a nonmalignant (by cytology) dominant main duct stricture with upstream ductal dilatation. A 7- or 10-Fr stent is inserted in a similar fashion to a biliary stent. Very tight strictures require dilation before stent placement. The following important points should be remembered: the stent diameter should not exceed the diameter of the stent downstream from the stricture; the stent should not be placed in such a way that the tip is abutting on or torqued into the duct wall; and one must carefully choose the shape and length of the stent so as to have the best fit and limit injury to the duct.

Outcome data from stent placement in various studies have been confusing. In an American Society for Gastrointestinal Endoscopy review of this topic, technical success rates of 82% to 100% have been quoted. These studies also found that 63% of patients reported some improvement of symptoms, complications occurred in 19% and mortality was 1%. These data are suspect, however, because some, but not all, patients subsequently underwent stent removal. The appropriate ‘duration’ of stenting is unclear: some stents are retained for one or two years without complication, whereas others occlude within weeks. Moreover, the duration of follow-up and the outcome measurements varied among different studies. Some patients underwent additional procedures, such as sphincterotomy and/or stone extraction. Success rates also seem to vary with the cause of pancreatitis, because some authors suggest that chronic alcoholics do not respond as favourably. Complications include stent occlusion (causing pain or pancreatitis), stent migration, infection, duct perforation ,and changes to the duct and parenchyma. You can be sure this pharmacy will offer the finest quality drugs you need, so buying birth control mircette will always be safe and very pleasant for you as a customer and patient.

While further study is needed, a trial of pancreatic duct stenting seems to be appropriate for patients with chronic pancreatitis and poorly responsive pain who exhibit a stricture of the main pancreatic duct and upstream ductal dilation.

This entry was posted in Pancreatic endoscopy and tagged Chronic pancreatitis, Pancreatic endoscopy.