Pancreatic Ductal Stent Placement for the Palliation of Pain in Patients With Pancreatic Adenocarcinoma, With and Without Pancreatic Ductal Dilatation

Abstract

Background: Endoscopic pancreatic duct stenting is commonly performed for pancreatic duct strictures and ductal dilatation. Though much less common than celiac plexus block, there are reports of the use of pancreatic duct stenting for the management of pain in patients with pancreatic cancer and pancreatic ductal dilatation. There are no published reports of pain relief with stenting in patients with pancreatic cancer without pancreatic ductal dilatation. Methods: A retrospective review was performed in two patients who underwent pancreatic duct stenting prior to a diagnosis of pancreatic carcinoma. Results: Two patients were evaluated for chronic abdominal pain. The first patient, was a 76 year-old male, with no significant past medical history who presented with greater than 6 months of worsening epigastric abdominal pain and a 22 pound weight loss. At the time of presentation, 2 computed tomography scans and magnetic resonance imaging had revealed pancreas divisum and pancreatic ductal dilatation without a pancreatic mass lesion. The second patient was a 41-year-old male with no significant past medical history who presented with chronic upper abdominal pain. His imaging had revealed an ill-defined retroperitoneal mass surrounding the proximal superior mesenteric artery (SMA). An EUS and biopsy had been negative for malignancy. The main pancreatic duct was not dilatated, and there was no intrahepatic biliary ductal dilatation. Both patients underwent ERCP with pancreatic duct stent placement (via the minor papilla and major papilla, respectively). Both patients experienced complete relief of their pain and their stents were subsequently removed. A diagnosis of adenocarcinoma was subsequently established in both patients by EUS and CT guided biopsy respectively. Conclusion: Relative to celiac plexus block, pancreatic duct stenting is much less commonly used in the palliation of pain in pancreatic adenocarcinoma. In two patients initially with chronic pain but without a diagnosis of malignancy, pancreatic ductal stenting provided complete relief, both in the presence and in the absence of pancreatic ductal dilatation. Further investigation may help determine the role of stent placement as compared to other interventions in patients with and without dilatation of the main pancreatic duct.