Endoscopic pancreatic duct stenting for relief of pancreatic cancer pain

Abstract

Little is known about the effects of endoscopic pancreatic duct (PD) decompression in patients with 'obstructive type' pain from pancreatic carcinoma. Twenty patients with unresectable carcinoma of the pancreas, PD obstruction and postprandial epigastric pain were enrolled. The pain intensity, opioid dose and quality-of-life index were documented pre-treatment and at 4-weekly intervals. PD stenting was attempted in all patients. PD stent change was performed if biliary stents had to be changed or intense pain relapsed. Endoscopic PD drainage was successful in 19/20 patients by placement of a 7 F (n = 9) or 10 F (n = 10) plastic stent. Median follow-up was 16 weeks. Two patients were alive at the end of follow-up. Eleven patients received gemcitabine chemotherapy. The pre-interventional pain score was 6.7 +/- 0.9 points and decreased to 3.1 +/-1.4 points at 4 weeks (P < 0.001). It remained lowered significantly at 8/12 weeks and at the final visit (4.2 +/- 1.5 points, n = 13). The mean pre-stenting fentanyl dose was 85.5 +/- 34.7 microg/h, and it was decreased to 57.9 +/- 39.1 microg/h after 4 weeks (P < 0.01), 60.5 +/- 38.9 microg/h after 8 weeks and 64.1+/-39.8 microg/h (P < 0.01 versus pre-treatment) after 12 weeks but increased to 82.7 +/- 41.3 microg/h (NS) at the final visit. The quality-of-life index improved 4 weeks after stenting (from 4.8+/-1 to 6.2+/-1.5 points, P < 0.01) but was lowered to 5.5 +/- 2.3 points at 12 weeks (NS). The response was independent of stent diameter and chemotherapy. PD stenting achieved significant pain relief and short-term improvement of the quality of life in the majority of patients with PD obstruction due to pancreatic carcinoma.