Background and Study Aims:Dominant pancreatic duct strictures located in the head of the pancreas in patients with severe chronic pancreatitis are often managed by endoscopic placement of a single plastic stent.Patien...Background and Study Aims:Dominant pancreatic duct strictures located in the head of the pancreas in patients with severe chronic pancreatitis are often managed by endoscopic placement of a single plastic stent.Patients with refractory strictures after prolonged stenting require repeated stent replacement or surgical pancreaticojejunostomy.Placement of multiple plastic stents has proved effective in managing postoperative biliary strictures.The aim of this study was to investigate the feasibility,efficacy,and long-term results of multiple stenting of refractory pancreatic strictures in severe chronic pancreatitis.Patients and Methods:19 patients with severe chronic pancreatitis(16 men,three women;mean age 45 years)and with a single pancreatic stent through a refractory dominant stricture in the pancreatic head underwent the following protocol:(i)removal of the single pancreatic stent;(ii)balloon dilation of the stricture;(iii)insertion of the maximum number of stents allowed by the stricture tightness and the pancreatic duct diameter;and(iv)removal of stents after 6 to 12 months.Results:The median number of stents placed through the major or minor papilla was 3,with diameters ranging from 8.5 to 11.5 Fr and length from 4 to 7 cm.Only one patient(5.5%)had persistent stricture after multiple stenting.During a mean follow-up of 38 months after removal,84%of patients were asymptomatic,and 10.5%had symptomatic stricture recurrence.No major complications were recorded.Conclusion:Endoscopic multiple stenting of dominant pancreatic duct strictures in chronic pancreatitis is a feasible and safe technique.Multiple pancreatic stenting is promising in obtaining persistent stricture dilation on long-term follow-up in the setting of severe chronic pancreatitis.展开更多
Background and Study Aims: Although it has been proved that pancreatic stentin g is effective in the symptomatic management of severe chronic pancreatitis, lon g-term outcomes after stent removal have not been fully e...Background and Study Aims: Although it has been proved that pancreatic stentin g is effective in the symptomatic management of severe chronic pancreatitis, lon g-term outcomes after stent removal have not been fully evaluated. Patients and Methods: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated fo r pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged “on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectiv ely assessed as potential predictors of re-stenting. Results: The etiology of t he chronic pancreatitis was alcoholic (77%), idiopathic (18%), or hereditary ( 5%). Patients were followed up for a median period of 69 months (range 14-163 months) after study entry, including a median period of 27 months (range 12 -12 6 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 -134 months). After attempted definitive stent removal, 30 patients (30%) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1-12 mon ths), while in 70 patients (70%) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had require d re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas di visum was the only factor significantly associated with a higher risk of re-ste nting (P = 0.002). Conclusions: The majority (70%) of patients with severe chro nic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However,a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.展开更多
文摘Background and Study Aims:Dominant pancreatic duct strictures located in the head of the pancreas in patients with severe chronic pancreatitis are often managed by endoscopic placement of a single plastic stent.Patients with refractory strictures after prolonged stenting require repeated stent replacement or surgical pancreaticojejunostomy.Placement of multiple plastic stents has proved effective in managing postoperative biliary strictures.The aim of this study was to investigate the feasibility,efficacy,and long-term results of multiple stenting of refractory pancreatic strictures in severe chronic pancreatitis.Patients and Methods:19 patients with severe chronic pancreatitis(16 men,three women;mean age 45 years)and with a single pancreatic stent through a refractory dominant stricture in the pancreatic head underwent the following protocol:(i)removal of the single pancreatic stent;(ii)balloon dilation of the stricture;(iii)insertion of the maximum number of stents allowed by the stricture tightness and the pancreatic duct diameter;and(iv)removal of stents after 6 to 12 months.Results:The median number of stents placed through the major or minor papilla was 3,with diameters ranging from 8.5 to 11.5 Fr and length from 4 to 7 cm.Only one patient(5.5%)had persistent stricture after multiple stenting.During a mean follow-up of 38 months after removal,84%of patients were asymptomatic,and 10.5%had symptomatic stricture recurrence.No major complications were recorded.Conclusion:Endoscopic multiple stenting of dominant pancreatic duct strictures in chronic pancreatitis is a feasible and safe technique.Multiple pancreatic stenting is promising in obtaining persistent stricture dilation on long-term follow-up in the setting of severe chronic pancreatitis.
文摘Background and Study Aims: Although it has been proved that pancreatic stentin g is effective in the symptomatic management of severe chronic pancreatitis, lon g-term outcomes after stent removal have not been fully evaluated. Patients and Methods: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated fo r pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged “on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectiv ely assessed as potential predictors of re-stenting. Results: The etiology of t he chronic pancreatitis was alcoholic (77%), idiopathic (18%), or hereditary ( 5%). Patients were followed up for a median period of 69 months (range 14-163 months) after study entry, including a median period of 27 months (range 12 -12 6 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 -134 months). After attempted definitive stent removal, 30 patients (30%) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1-12 mon ths), while in 70 patients (70%) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had require d re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas di visum was the only factor significantly associated with a higher risk of re-ste nting (P = 0.002). Conclusions: The majority (70%) of patients with severe chro nic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However,a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.
