The transpapillary approach involves placing the stent into the pseudocyst either directly through the pancreatic duct or by traversing the ductal communication. Although this technique is less likely to cause bleeding than the transgut approach, it is associated with an increased risk of infection. This is occasionally combined with percutaneous drainage. Transpapillary drainage is appropriate if the disruption occurs in a side branch of the main pancreatic duct, or occasionally if there is leakage from the end of the duct. Another approach, such as surgical drainage, should be considered if there is a large communication with the pseudocyst or significant debris within the lesion, or if stent placement does not appear to be optimal.
Pancreatic duct strictures make endoscopic treatment more difficult, because ‘downstream’ obstruction leads to the persistence or recurrence of the pseudocyst. It is important to use the shortest possible stent and to remove the stent after the pseudocyst resolves, to minimize ductal injury. These considerations may be less important, however, in patients with chronic pancreatitis. Take advantage of this unique opportunity to pay less money and get yourself a trusted pharmacy where you can always enjoy a chance to buy glucophage and be sure you will enjoy lowest prices online.
While endopancreatic therapy appears to be of value in the treatment of pain associated with chronic pancreatitis, prospective data are still needed to validate this technique. For now, most experts recommend that these techniques be performed only by experienced endoscopists in centres that can deal with any complications.