The Efficacy of Pancreatic Stenting After Clearance of Pancreatic Stones

Abstract

Background & Aim: Extracorporeal shockwave lithotripsy (ESWL) and endoscopic lithotripsy are useful for fragmentation and extraction of pancreatic stones. However, the stones are often recurrent because of the stricture of main pancreatic duct (MPD), and more applicant strategy is needed. Treatment of the stricture of MPD with pancreatic stent after clearance of the pancreatic stones may reduce the recurrence of pancreatic symptoms and pancreatic stones. Therefore, we analyzed the efficacy of pancreatic stenting after stone extraction. Patients & Methods: Thirty-seven patients with chronic pancreatitis with main pancreatic duct stones were treated with ESWL in combination with endoscopic extraction between January 1998 and October 2004. If there were one or more severe strictures in main pancreatic duct (MPD) on pancreatography at the end of complete stone clearance of MPD or at the time of recurrent pancreatic symptoms, a 7Fr, 8.5Fr or 10Fr polyethylene stent was inserted after balloon dilation of the stricture and the papilla of Vater so that all strictures were bypassed. The inserted stent was exchanged every three months or soon after any symptoms due to occlusion, and removed after one year. Episode of recurrent pain and pancreatitis were examined after the treatment. Results: Twenty-eight of 37 patients received stenting therapy, 25 immediately after the stone clearance and 3 at the time of recurrent pancreatic symptoms 10 to 15 months after the clearance of the stone. Pancreatic symptoms were improved in all patients immediately after initial stenting. The recurrence of any pancreatic symptoms after one year's stenting was seen in 7 cases (25%) in the mean follow up periods of 26 months and recurrence rate in one and two year was 21% and 37%, respectively. The recurrence of pancreatic stones was seen in 5 of 7 patients with the recurrent symptoms and all of them were extractable without mechanical lithotripsy or ESWL. Acute pancreatitis without recurrence of stones was seen in the other two patients and all of them were treated conservatively. There were only two patients who needed another stenting for MPD stricture Conclusion: Additional stenting for the main pancreatic duct after extraction of pancreatic stones might be effective in patients with pancreatic stones and severe strictures in MPD. The better protocol for stenting could improve the recurrent pancreatic symptoms after removal of the stent.