Endoscopic Treatment of Chronic Pancreatitis: Long-Term Results

Abstract

Endoscopic pancreatic stenting is nowadays considered to be the first intent therapeutic approach in case of painful chronic pancreatitis with dilation of the main pancreatic duct (MPD). While short-term effects of this treatment have been well evaluated and are satisfactory, long-term results are still uncertain. Definitive pancreatic stenting with exchange on demand could be the solution to prevent pain recurrence. Long term results of definitive stenting were analyzed from a series of 40 patients. Methods: 40 consecutive patients treated by endoscopic stenting because of a MPD dilation were followed for at least 60 months. The multihole plastic 10F stent was inserted till the tail of the pancreas, once the vacuity of the MPD was obtained following pancreatic sphincterotomy, pancreatic duct stenosis dilation, stone extraction and if necessary extracorporeal lithotripsy (11 cases). Follow-up was ensured by annual CT or MRCP, and liver tests. Results: 19 patients (47%) still have the stent in place without pain. In this group of patients, the mean frequency of stent exchange was 0.84:10 patients had had no stent exchange. In 9 cases, surgical pancreatic bypass or resection was finally performed: in 5 cases because a symptomatic main bile duct stenosis occurred (biliary and pancreatic bypasses), in 3 cases because of a perisplenic abcess following stent obstruction in patients who presented initially an associated stenosis of the caudal MPD (left splenopancreatectomy with wirsungo-jejunal anastomosis), in one case because a pancreatic carcinoma occurred (Whipple resection). In 2 cases, the stent migrated without pain recurrence. Finally 10 patients died for causes not related to the treatment or to the chronic pancreatitis (6 deaths related to the alcohol-tobacco abuse). Conclusion: Long-term follow-up demonstrates that in 3/4 of cases, endoscopic treatment by definitive pancreatic stenting is sufficient: ½ of the patients have no more pain or ¼ died from other diseases. The more severe complication is perisplenic abcesses in patients who has initially an associated caudal MPD stenosis despite stenosis was crossed by the stent. This associated stenosis could a better indication for initial surgical resection. The prognosis of the patients is mainly related to the alcohol-tobacco abuse than to the chronic pancreatitis itself.