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Traitement endoscopique interventionnel de la douleur dans la pancréatite chronique

Interventional endoscopic therapy for pain in chronic pancreatitis

  • Published:
Acta Endoscopica

Résumé

Dans la pancréatite chronique, la douleur est causée par différents mécanismes. La pression canalaire augmentée, les obstructions intracanalaires, les pseudo-kystes et les sténoses biliaires associées peuvent être traités par endoscopie. Les outils de l’endoscopiste sont: la papillotomie, la pose de prothèse du canal pancréatique et/ou biliaire, la dilatation des rétrécissements pancréatiques, l’extraction de calculs combinés à la lithotritie extracorporéale par onde de choc, le drainage naso-pancréatique transitoire, la lithotritie mécanique et la pancréatoscopie. Nous rapportons les résultats à moyen terme (r=234–1095 d) d’une étude prospective non contrôlée chez 68 patients entre 1992 et 1994 concernant la thérapie endoscopique dans la pancréatite chronique avec douleur associée. Le taux de succès technique a été de 89%. Des complications sont survenues chez 8 % des patients. Au départ, un soulagement total de la douleur a pu être observé chez 63 % des patients et un soulagement partiel chez 19%. Pour 8 %, il a fallu recourir à la chirurgie en raison de douleurs persistantes. Au cours du suivi, 37 % des patients ont enregistré un soulagement permanent de la douleur. 53 % ont subi une réintervention endoscopique qui a eu pour résultat un soulagement permanent chez 6 %, une amélioration temporaire chez 39 % et une douleur réfractaire au traitement chez 8%. Ces derniers patients ont également été orientés vers la chirurgie. Les procédés techniques utilisés sont décrits et comparés à la littérature. Une étude des résultats endoscopiques et chirurgicaux dans le traitement de la pancréatite chronique est présentée.

Summary

In chronic pancreatitis, pain is caused by different mechanisms. The increased ductal pressure, obstructions within the ductal system, pseudocysts, and accompanying biliary strictures can be managed endoscopically. The endoscopist’s tools are papillotomy, stenting of the pancreatic and/or biliary tract, dilation of pancreatic strictures, stone extraction in combination with extracorporeal shock wave lithotripsy, transitory nasopancreatic drainage, mechanical lithotripsy and pancreatoscopy. We report our medium-term (r=234–1095 d) follow-up results of an uncontrolled prospective study in 68 patients from 1992 – 1994 concerning endoscopic therapy in chronic pancreatitis with pain. The technical success rate was 89 %. Complications occurred in 8 % of patients. Initially, total relief of pain was noted in 63 % of patients, partial relief in 19 %. In 8 % surgery was carried out for persistent pain. During follow-up 37% of patients showed persistent relief of pain. 53 % underwent endoscopic reintervention, leading to permanent remission in 6 %, intermittent improval in 39 % and refractory pain in 8 %. The latter patients were referred to surgery as well. The technical procedures used are described and compared to literature. A survey on the endoscopical and surgical data in the treatment of chronic pancreatitis is supplied.

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  1. A. Zipf

    Present address: II. Medizinische Klinik der Johann-Wolfgang-Goethe-Universität, D-60590, Frankfurt/Main, Germany

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  1. Innere Abteilung des St. Hildegardiskrankenhaus der Universität, D-55131, Mainz, Germany

    M. Jung

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Zipf, A., Jung, M. Traitement endoscopique interventionnel de la douleur dans la pancréatite chronique. Acta Endosc 27, 13–25 (1997). https://doi.org/10.1007/BF02963279

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