Long-term outcome after pancreatic stenting in severe chronic pancreatitis.

Abstract

BACKGROUND AND STUDY AIMS:

Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-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 for 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 retrospectively assessed as potential predictors of re-stenting.

RESULTS:

The etiology of the 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 - 126 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 months), 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 required re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002).

CONCLUSIONS:

The majority (70 %) of patients with severe chronic 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.

• Authors: N Eleftherladis, F Dinu, M Delhaye, O Le Moine, M Baize, A Vandermeeren, L Hookey, J Devière
• Journal: Endoscopy (Endoscopy) Vol. 37 Issue 3 Pg. 223-30 (Mar 2005) ISSN: 0013-726X [Print] Germany
• PMID: 18556820 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Drainage
• Endoscopy, Gastrointestinal
• Female
• Humans
• Male
• Middle Aged
• Pain (prevention & control)
• Pancreatic Ducts
• Pancreatitis, Chronic (therapy)
• Stents
• Treatment Outcome