Stenting does not decompress the pancreatic duct as effectively as surgery in experimental chronic pancreatitis

Abstract

Background: In humans with chronic pancreatitis (CP), pancreatic interstitial pressure (IP) is elevated and pancreatic blood flow (PBF) is reduced. The efficacy of surgical decompression (SD) of the pancreatic duct (ie, pancreaticojejunostomy) is believed to be due to its ability to decrease IP and pancreatic vascular resistance (R p), which increases PBF. Pancreatic duct stenting (STE) also probably reduces IP and R p, which may explain its efficacy. The purpose of this study was to compare the efficacy of SD with STE. Methods: CP in cats was created by narrowing the main pancreatic duct. Six weeks later, CP and normal pancreata were isolated and perfused ex vivo under basal conditions and after secretin stimulation. In normal and CP glands, IP and perfusion pressure were measured and R p (U) was calculated. In two additional groups, the pancreatic duct was decompressed, either by stenting or by complete transection of the duct with a longitudinal capsulotomy. Results: In CP glands, IP and R p were increased and secretory output was markedly reduced compared with the normal (0.65 ± 0.30 mm Hg and 0.46 ± 0.04 U vs 3.90 ± 0.80 mm Hg and 1.68 ± 0.05 U; P < .05). Secretin administration (2 units) increased IP and R p in CP glands (6.60 ± 1.10 mm Hg and 2.87 ± 0.07 U; P < .05), but these values did not change in normal glands (0.81 ± 0.20 and 0.53 ± 0.03 U; NS). STE and SD decreased IP and R p in CP glands ( 2.20 ± 0.20 to 1.0 ± 0.40 mm Hg and 1.20 ± 0.015 to 0.90 ± 0.01 U, respectively; P < .05). Both methods prevented an increase of IP and R p after secretin administration. IP and R p decreased to a greater degree following SD, compared with STE ( P < .05). Conclusions: Both STE and SD decreased IP and R p in this experimental model of CP. However, SD was significantly more effective than STE. (Surgery 1998;124:561-7.)