CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(09): E1130-E1134
DOI: 10.1055/a-0841-3385
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study

Jean-Michel Gonzalez
1   Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France
,
Diane Lorenzo
1   Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France
2   APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
,
Jean-Philippe Ratone
3   Institut Paoli Calmette, UEMCO, Marseille, France
,
Adrian Culetto
4   CHU de Purpan, Department of Gastroenterology, Toulouse, France
,
Frédérique Maire
2   APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
,
Philippe Levy
2   APHP, Hôpital Beaujon, Department of Pancreatology, Clichy-la-Garenne, Paris, France
,
Marc Giovannini
3   Institut Paoli Calmette, UEMCO, Marseille, France
,
Marc Barthet
1   Aix-Marseille University, APHM, Hôpital Nord, Department of Gastroenterology, Marseille, France
› Author Affiliations
Further Information

Publication History

submitted 10 August 2018

accepted after revision 27 December 2018

Publication Date:
29 August 2019 (online)

Abstract

Introduction Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) require follow-up to detect worrisome features (WF). Data are missing about endoscopic pancreatic sphincterotomy (PS) for symptomatic IPMN.

Patients and methods This was a retrospective multicenter study in four expert centers. Patients treated with endoscopic PS for symptomatic (painful) BD-IPMN without WF were included. Age, sex, follow-up time, characteristics of IPMNs and endoscopic retrograde cholangiopancreatographies (ERCPs), and indications for surgery were recorded.

Results In total, 21 patients were included (median age 68 years, range 45 – 87 years). The median number of cysts was 2 (range 1 – 10), located in the head (59 %), body/tail (17 %), or multifocal (24 %). ERCP including PS was completed in all of the cases, with biliary sphincterotomy in 33 %. Clinical efficacy after one session was 81 % (17/21). Among the failures, one had a second successful PS and three were operated. The final efficacy was 86 % (18/21). Seven patients were operated after a mean of 19 months: four for WF, three for pain. The histopathology showed four low grade dysplasia, one high grade dysplasia, and two no dysplasia. No adenocarcinoma occurred during a follow-up of 99 months (range 14 – 276 months).

Conclusions Endoscopic PS for symptomatic IPMN without WF is effective in more than 80 % of cases, without increasing the risk for adenocarcinoma.

 
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