Abstract
Background
Extracorporeal shockwave lithotripsy (ESWL) and endoscopic lithotripsy are useful for the fragmentation and extraction of pancreatic stones. However, pancreatic stones often recur, for which an adequate strategy is needed. Treatment for stricture of the main pancreatic duct (MPD) with a pancreatic stent after clearance of pancreatic stones may reduce the recurrence of pancreatic symptoms and stones.
Methods
Forty patients with chronic pancreatitis with MPD stones were treated with ESWL in combination with endoscopic stone extraction. After clearance of the stones, a pancreatic stent was inserted when a stricture of MPD was observed on pancreatography. The stent was exchanged every 3 months and removed after a total of 1 year. We examined episodes of recurrent pain and pancreatitis in patients with and without stenting, as well as the MPD diameter, during follow-up.
Results
MPD stricture was seen in 27 patients, and a stent was successfully inserted in 24 of them. Pancreatic symptoms recurred in five patients (21%) in the stenting group and in three patients (23%) in the control group during a mean follow-up period of 1.5 and 1.2 years, respectively. The diameter of the MPD, before, just after, and 1 year after treatment, was 7.6, 5.4, and 5.8 mm, respectively. It was significantly decreased after 1 year of follow-up, as well as just after stent removal, compared with before treatment (P < 0.05).
Conclusions
Additional stenting for MPD after extraction of pancreatic stones may reduce the risk of recurrence of pancreatic symptoms.
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References
G Kloppel B Maillet (1992) ArticleTitleThe morphological basis for the evolution of acute pancreatitis into chronic pancreatitis Virchows Arch A Pathol Anat Histopathol 420 1–4 10.1007/BF01605976 Occurrence Handle10.1007/BF01605976 Occurrence Handle1:STN:280:DyaK387ntVSmug%3D%3D Occurrence Handle1539444
ML Steer I Waxman S Freedman (1995) ArticleTitleChronic pancreatitis N Engl J Med 332 1482–90 10.1056/NEJM199506013322206 Occurrence Handle10.1056/NEJM199506013322206 Occurrence Handle1:STN:280:DyaK2M3lvVSqtQ%3D%3D Occurrence Handle7739686
RW Ammann A Akovbiantz F Largiader G Schueler (1984) ArticleTitleCourse and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients Gastroenterology 86 820–8 Occurrence Handle1:STN:280:DyaL2c7lvFeluw%3D%3D Occurrence Handle6706066
AL Widdison C Alvarez ND Karanjia HA Reber (1991) ArticleTitleExperimental evidence of beneficial effects of ductal decompression in chronic pancreatitis Endoscopy 23 151–4 Occurrence Handle10.1055/s-2007-1010645 Occurrence Handle1:STN:280:DyaK3MzhslWmtQ%3D%3D Occurrence Handle1860444
N Ebbehoj L Borly J Bulow SG Rasmussen P Madsen (1990) ArticleTitleEvaluation of pancreatic tissue fluid pressure and pain in chronic pancreatitis. A longitudinal study Scand J Gastroenterol 25 462–6 Occurrence Handle10.3109/00365529009095516 Occurrence Handle1:STN:280:DyaK3c3psF2nsQ%3D%3D Occurrence Handle2359973
EL Bradley Suffix3rd (1982) ArticleTitlePancreatic duct pressure in chronic pancreatitis Am J Surg 144 313–6 10.1016/0002-9610(82)90008-3 Occurrence Handle10.1016/0002-9610(82)90008-3 Occurrence Handle7114368
AR Moossa (1987) ArticleTitleSurgical treatment of chronic pancreatitis: an overview Br J Surg 74 661–7 Occurrence Handle10.1002/bjs.1800740803 Occurrence Handle1:STN:280:DyaL1c%2FgtFaluw%3D%3D Occurrence Handle3307990
PF Partington RE Rochelle (1960) ArticleTitleModified Puestow procedure for retrograde drainage of the pancreatic duct Ann Surg 152 1037–43 Occurrence Handle10.1097/00000658-196012000-00015 Occurrence Handle1:STN:280:DyaF3c%2Flt1KrsA%3D%3D Occurrence Handle13733040
EL Bradley Suffix3rd (1987) ArticleTitleLong-term results of pancreatojejunostomy in patients with chronic pancreatitis Am J Surg 153 207–13 10.1016/0002-9610(87)90816-6 Occurrence Handle10.1016/0002-9610(87)90816-6 Occurrence Handle3812895
RA Prinz HB Greenlee (1981) ArticleTitlePancreatic duct drainage in 100 patients with chronic pancreatitis Ann Surg 194 313–20 10.1097/00000658-198109000-00009 Occurrence Handle10.1097/00000658-198109000-00009 Occurrence Handle1:STN:280:DyaL3M3otVOrtA%3D%3D Occurrence Handle7271348
DB Adams MC Ford MC Anderson (1994) ArticleTitleOutcome after lateral pancreaticojejunostomy for chronic pancreatitis Ann Surg 219 481–7 10.1097/00000658-199405000-00006 Occurrence Handle10.1097/00000658-199405000-00006 Occurrence Handle1:STN:280:DyaK2c3ktFOqtg%3D%3D Occurrence Handle8185399
T Sauerbruch J Holl M Sackmann R Werner R Wotzka G Paumgartner (1987) ArticleTitleDisintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis Endoscopy 19 207–8 Occurrence Handle10.1055/s-2007-1018284 Occurrence Handle1:STN:280:DyaL1c%2FlsVyquw%3D%3D Occurrence Handle3678162
M Delhaye A Vandermeeren M Baize M Cremer (1992) ArticleTitleExtracorporeal shock-wave lithotripsy of pancreatic calculi Gastroenterology 102 610–20 Occurrence Handle1:STN:280:DyaK387itVeqsA%3D%3D Occurrence Handle1732129
T Sauerbruch J Holl M Sackmann G Paumgartner (1992) ArticleTitleExtracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study Gut 33 969–72 Occurrence Handle10.1136/gut.33.7.969 Occurrence Handle1:STN:280:DyaK38zlsV2ksg%3D%3D Occurrence Handle1644340
RA Kozarek TJ Ball DJ Patterson JJ Brandabur LW Traverso S Raltz (1994) ArticleTitleEndoscopic pancreatic duct sphincterotomy: indications, technique, and analysis of results Gastrointest Endosc 40 592–8 Occurrence Handle1:STN:280:DyaK2M%2FotVGnsg%3D%3D Occurrence Handle7988825 Occurrence Handle10.1016/S0016-5107(94)70260-8
ME Smits EA Rauws GN Tytgat K Huibregtse (1996) ArticleTitleEndoscopic treatment of pancreatic stones in patients with chronic pancreatitis Gastrointest Endosc 43 556–60 10.1016/S0016-5107(96)70190-6 Occurrence Handle10.1016/S0016-5107(96)70190-6 Occurrence Handle1:STN:280:DyaK28znsFKnsQ%3D%3D Occurrence Handle8781932
H Ohara M Hoshino T Hayakawa Y Kamiya M Miyaji T Takeuchi et al. (1996) ArticleTitleSingle application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones Am J Gastroenterol 91 1388–94 Occurrence Handle1:STN:280:DyaK283otVGisw%3D%3D Occurrence Handle8678001
G Costamagna A Gabbrielli M Mutignani V Perri M Pandolfi M Boscaini et al. (1997) ArticleTitleExtracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results Gastrointest Endosc 46 231–6 10.1016/S0016-5107(97)70092-0 Occurrence Handle10.1016/S0016-5107(97)70092-0 Occurrence Handle1:STN:280:DyaK1c%2Fhsl2rsA%3D%3D Occurrence Handle9378210
HE Adamek R Jakobs A Buttmann MU Adamek AR Schneider JF Riemann (1999) ArticleTitleLong term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy Gut 45 402–5 Occurrence Handle1:STN:280:DyaK1Mzns12jtw%3D%3D Occurrence Handle10446109 Occurrence Handle10.1136/gut.45.3.402
B Brand M Kahl S Sidhu VC Nam PV Sriram S Jaeckle et al. (2000) ArticleTitleProspective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis Am J Gastroenterol 95 3428–38 10.1111/j.1572-0241.2000.03190.x Occurrence Handle10.1111/j.1572-0241.2000.03190.x Occurrence Handle1:STN:280:DC%2BD3M%2FpvFSntw%3D%3D Occurrence Handle11151873
RA Kozarek JJ Brandabur TJ Ball M Gluck DJ Patterson F Attia et al. (2002) ArticleTitleClinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis Gastrointest Endosc 56 496–500 10.1016/S0016-5107(02)70432-X Occurrence Handle10.1016/S0016-5107(02)70432-X Occurrence Handle12297763
MJ Farnbacher C Schoen T Rabenstein J Benninger EG Hahn HT Schneider (2002) ArticleTitlePancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success Gastrointest Endosc 56 501–6 10.1016/S0016-5107(02)70433-1 Occurrence Handle10.1016/S0016-5107(02)70433-1 Occurrence Handle12297764
T Fuji H Amano K Harima T Aibe F Asagami K Kinukawa et al. (1985) ArticleTitlePancreatic sphincterotomy and pancreatic endoprosthesis Endoscopy 17 69–72 Occurrence Handle10.1055/s-2007-1018460 Occurrence Handle1:STN:280:DyaL2M7nvFentg%3D%3D Occurrence Handle3987635
K Huibregtse B Schneider AA Vrij GN Tytgat (1988) ArticleTitleEndoscopic pancreatic drainage in chronic pancreatitis Gastrointest Endosc 34 9–15 Occurrence Handle10.1016/S0016-5107(88)71221-3 Occurrence Handle1:STN:280:DyaL1c7mslKlug%3D%3D Occurrence Handle3350319
J McCarthy JE Geenen WJ Hogan (1988) ArticleTitlePreliminary experience with endoscopic stent placement in benign pancreatic diseases Gastrointest Endosc 34 16–8 Occurrence Handle10.1016/S0016-5107(88)71222-5 Occurrence Handle1:STN:280:DyaL1c7mslKguw%3D%3D Occurrence Handle3350298
H Grimm WH Meyer VC Nam N Soehendra (1989) ArticleTitleNew modalities for treating chronic pancreatitis Endoscopy 21 70–4 Occurrence Handle10.1055/s-2007-1012903 Occurrence Handle1:STN:280:DyaL1M3htVGltA%3D%3D Occurrence Handle2707174
M Cremer J Deviere M Delhaye M Baize A Vandermeeren (1991) ArticleTitleStenting in severe chronic pancreatitis: results of mediumterm follow-up in seventy-six patients Endoscopy 23 171–6 Occurrence Handle10.1055/s-2007-1010649 Occurrence Handle1:STN:280:DyaK3MzhslWlsw%3D%3D Occurrence Handle1860448
K Ashby SK Lo (1995) ArticleTitleThe role of pancreatic stenting in obstructive ductal disorders other than pancreas divisum Gastrointest Endosc 42 306–11 10.1016/S0016-5107(95)70127-3 Occurrence Handle10.1016/S0016-5107(95)70127-3 Occurrence Handle1:STN:280:DyaK287itFehsg%3D%3D Occurrence Handle8536897
T Ponchon RM Bory F Hedelius LD Roubein P Paliard B Napoleon et al. (1995) ArticleTitleEndoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol Gastrointest Endosc 42 452–6 10.1016/S0016-5107(95)70049-8 Occurrence Handle10.1016/S0016-5107(95)70049-8 Occurrence Handle1:STN:280:DyaK287kvFKltw%3D%3D Occurrence Handle8566637
ME Smits SM Badiga EA Rauws GN Tytgat K Huibregtse (1995) ArticleTitleLong-term results of pancreatic stents in chronic pancreatitis Gastrointest Endosc 42 461–7 10.1016/S0016-5107(95)70051-X Occurrence Handle10.1016/S0016-5107(95)70051-X Occurrence Handle1:STN:280:DyaK287kvFKltQ%3D%3D Occurrence Handle8566639
KF Binmoeller P Jue H Seifert WC Nam J Izbicki N Soehendra (1995) ArticleTitleEndoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results Endoscopy 27 638–44 Occurrence Handle10.1055/s-2007-1005780 Occurrence Handle1:STN:280:DyaK2s%2FlvFKmtg%3D%3D Occurrence Handle8903975
P Dite M Ruzicka V Zboril I Novotny (2003) ArticleTitleA prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis Endoscopy 35 553–8 10.1055/s-2003-40237 Occurrence Handle10.1055/s-2003-40237 Occurrence Handle1:STN:280:DC%2BD3szjsF2guw%3D%3D Occurrence Handle12822088
AT Axon M Classen PB Cotton M Cremer PC Freeny WR Lees (1984) ArticleTitlePancreatography in chronic pancreatitis: international definitions Gut 25 1107–12 Occurrence Handle10.1136/gut.25.10.1107 Occurrence Handle1:STN:280:DyaL2M%2FgsVymsg%3D%3D Occurrence Handle6479687
Y Komatsu T Kawabe N Toda M Ohashi M Isayama K Tateishi et al. (1998) ArticleTitleEndoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases Endoscopy 30 12–7 Occurrence Handle10.1055/s-2007-993721 Occurrence Handle1:STN:280:DyaK1c3gvFamug%3D%3D Occurrence Handle9548037
T Kawabe Y Komatsu M Tada N Toda M Ohashi Y Shiratori et al. (1996) ArticleTitleEndoscopic papillary balloon dilation in cirrhotic patients: removal of common bile duct stones without sphincterotomy Endoscopy 28 694–8 Occurrence Handle10.1055/s-2007-1005579 Occurrence Handle1:STN:280:DyaK2s%2FovVWmsg%3D%3D Occurrence Handle8934088
T Rosch S Daniel M Scholz K Huibregtse M Smits T Schneider et al. (2002) ArticleTitleEuropean Society of Gastrointestinal Endoscopy Research Group. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up Endoscopy 34 765–71 10.1055/s-2002-34256 Occurrence Handle10.1055/s-2002-34256 Occurrence Handle1:STN:280:DC%2BD38vot1SgsQ%3D%3D Occurrence Handle12244496
RA Kozarek (1990) ArticleTitlePancreatic stents can induce ductal changes consistent with chronic pancreatitis Gastrointest Endosc 36 93–5 Occurrence Handle10.1016/S0016-5107(90)70958-3 Occurrence Handle1:STN:280:DyaK3c3ktlWgsQ%3D%3D Occurrence Handle2335298
MT Smith S Sherman SO Ikenberry RH Hawes GA Lehman (1996) ArticleTitleAlterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy Gastrointest Endosc 44 268–75 10.1016/S0016-5107(96)70163-3 Occurrence Handle10.1016/S0016-5107(96)70163-3 Occurrence Handle1:STN:280:DyaK2s%2FjvFOquw%3D%3D Occurrence Handle8885345
S Sherman RH Hawes TJ Savides FG Gress SO Ikenberry MT Smith et al. (1996) ArticleTitleStent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP Gastrointest Endosc 44 276–82 10.1016/S0016-5107(96)70164-5 Occurrence Handle10.1016/S0016-5107(96)70164-5 Occurrence Handle1:STN:280:DyaK2s%2FjvFyjsg%3D%3D Occurrence Handle8885346
DJ Gulliver S Edmunds ME Baker S Paine J Baillie PB Cotton et al. (1992) ArticleTitleStent placement for benign pancreatic diseases: correlation between ERCP findings and clinical response AJR Am J Roentgenol 159 751–5 Occurrence Handle1:STN:280:DyaK38vhtFSltg%3D%3D Occurrence Handle1529836
DE Morgan JK Smith K Hawkins CM Wilcox (2003) ArticleTitleEndoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency Am J Gastroenterol 98 821–6 10.1111/j.1572-0241.2003.07381.x Occurrence Handle10.1111/j.1572-0241.2003.07381.x Occurrence Handle12738462
JI Lans JE Geenen JF Johanson WJ Hogan (1992) ArticleTitleEndoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial Gastrointest Endosc 38 430–4 10.1016/S0016-5107(92)70471-4 Occurrence Handle10.1016/S0016-5107(92)70471-4 Occurrence Handle1:STN:280:DyaK38zotVeksA%3D%3D Occurrence Handle1511816
L Jacob JE Geenen MF Catalano DJ Geenen (2001) ArticleTitlePrevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents Endoscopy 33 559–62 10.1055/s-2001-15314 Occurrence Handle10.1055/s-2001-15314 Occurrence Handle1:STN:280:DC%2BD38%2FisFKmsQ%3D%3D Occurrence Handle11473324
SO Ikenberry S Sherman RH Hawes M Smith GA Lehman (1994) ArticleTitleThe occlusion rate of pancreatic stents Gastrointest Endosc 40 611–3 Occurrence Handle1:STN:280:DyaK2M%2FotVGntg%3D%3D Occurrence Handle7988829 Occurrence Handle10.1016/S0016-5107(94)70264-0
A Ertan (2000) ArticleTitleLong-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum Gastrointest Endosc 52 9–14 10.1067/mge.2000.106311 Occurrence Handle10.1067/mge.2000.106311 Occurrence Handle1:STN:280:DC%2BD3cvlslyhtg%3D%3D Occurrence Handle10882955
R Kozarek O Hovde F Attia R France (2003) ArticleTitleDo pancreatic duct stents cause or prevent pancreatic sepsis? Gastrointest Endosc 58 505–9 10.1067/S0016-5107(03)01891-1 Occurrence Handle10.1067/S0016-5107(03)01891-1 Occurrence Handle14520281
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Sasahira, N., Tada, M., Isayama, H. et al. Outcomes after clearance of pancreatic stones with or without pancreatic stenting. J Gastroenterol 42, 63–69 (2007). https://doi.org/10.1007/s00535-006-1972-1
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DOI: https://doi.org/10.1007/s00535-006-1972-1