RSS-Feed abonnieren
DOI: 10.1055/s-2005-860988
Long-Term Outcome after Pancreatic Stenting in Severe Chronic Pancreatitis
* Joint first authorsPublikationsverlauf
Submitted 9 July 2004
Accepted after Revision 1 October 2004
Publikationsdatum:
24. Februar 2005 (online)
![](https://www.thieme-connect.de/media/endoscopy/200503/lookinside/thumbnails/10.1055-s-2005-860988-1.jpg)
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.
References
- 1 Huibregtse K, Schneider B, Vrij A A, Tytgat G N. Endoscopic pancreatic drainage in chronic pancreatitis. Gastrointest Endosc. 1988; 34 9-15
- 2 Cremer M, Devière J, Delhaye M. et al . Stenting in severe chronic pancreatitis: results of medium-term follow-up in 76 patients. Endoscopy. 1991; 23 171-176
- 3 Binmoeller K F, Jue P, Seifert H. et al . Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy. 1995; 27 638-644
- 4 Ponchon T, Bory R M, Hedelius F. et al . Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. Gastrointest Endosc. 1995; 42 452-456
- 5 Smits M E, Badiga S M, Rauws E A. et al . Long-term results of pancreatic stents in chronic pancreatitis. Gastrointest Endosc. 1995; 42 461-467
- 6 Devière J, Delhaye M, Cremer M. Pancreatic duct stones management. Gastrointest Endosc Clin N Am. 1998; 8 163-179
- 7 Delhaye M, Matos C, Devière J. Endoscopic management of chronic pancreatitis. Gastrointest Endosc Clin N Am. 2003; 13 717-742
- 8 Cremer M, Toussaint J, Hermanus A. et al . Les pancréatites chroniques primitives: classification sur base de la pancréatographie endoscopique. Acta Gastroenterol Belg. 1976; 39 522-546
- 9 Ammann R W, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis. Gastroenterology. 1999; 116 1132-1140
- 10 Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003; 35 553-558
- 11 Rosch T, Daniel S, Scholz M. et al . Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy. 2002; 34 765-771
- 12 Neuhaus H. Therapeutic pancreatic endoscopy. Endoscopy. 2004; 36 8-16
- 13 Barthet M. Traitement endoscopique de la pancréatite chronique. Gastroenterol Clin Biol. 2002; 26 B130-B139
- 14 Boerma D, Huibregtse K, Gulik T M. et al . Long-term outcome of endoscopic stent placement for chronic pancreatitis associated with pancreas divisum. Endoscopy. 2000; 32 452-456
- 15 Lehman G A, Sherman S. Diagnosis and therapy of pancreas divisum. Gastrointest Endosc Clin N Am. 1998; 8 55-77
- 16 Talamini G, Bassi C, Falconi M. et al . Pain relapses in the first 10 years of chronic pancreatitis. Am J Surg. 1996; 171 565-569
J. Devière, M. D.
Department of Gastroenterology, Université Libre de Bruxelles, Hôpital Erasme
Route de Lennik 808 · 1070 Brussels · Belgium
Fax: +32-02-555-4697
eMail: jdeviere@ulb.ac.be