Summary
Background and Aim. During the course of chronic pancreatitis, the gradual increase in the main pancreatic duct pressure is the main pathophysiological factor responsible for pain, but up to now, the intraductal pressure has never been measured during and after endoscopic stenting and correlated with clinical results. Pressure measurements of this kind could thus provide objective information about the useful duration of stenting period.
Methods. Main pancreatic duct pressure was measured by performing endoscopic manometry on 13 chronic pancreatitis symptomatic patients (10 men, 3 women, mean age: 45.1 ± 7.9 yr); clinical follow-up was carried out for a period of 29.0±16.1 mo. Before treatment, the main anatomical alteration present was a localized stenosis of the main pancreatic duct, i.e., one with a diameter of less than 2 mm (chronic pancreatitis alone), 10 cases; chronic pancreatitis associated with pancreas divisum, 3 cases). Stenosis was treated by endoscopic stenting: 7 F stent (7 cases) and 12 F stent (6 cases). The pressure was measured simultaneously in the duodenum (zero level) and within the main pancreatic duct, using an electronic device. The pancreatico-duodenal gradient was taken to be the difference between the pressure in the main pancreatic duct and the duodenum.
Results. The endoscopic stenting induced a nonsignificant decrease in the intraductal pressure (p=0.16). Among the 9 patients with a normal pressure at the end of the stenting and a successful anatomical outcome, 6 were painless during the follow-up period whereas 3 presented with recurrent pancreatic-type pain. The remaining 4 patients were symptom-free during the entire follow-up period, although the main pancreatic duct pressure was high at the end of the stenting and the stenosis was not completely cured.
Conclusion. The intraductal pressure at the end of the stenting period was perfectly correlated with the anatomical result, whether or not it was successful, but was not an accurate predictor of a favorable clinical outcome in patients with a poor anatomical result.
Similar content being viewed by others
References
Widdison A, Alvarez C, Karanjia N, Reber H. Experimental evidence of beneficial effects of ductal decompression in chronic pancreatitis. Endoscopy 1991; 23: 151–154.
Ebbehoj N, Borly L, Bülow J, Rasmussen SG, Masden P, Matzen P, Owre A. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function. Scand J Gastroenterol 1990; 25: 1046–1051.
Bradley EL. Pancreatic duct pressure in chronic pancreatitis. Am J Surg 1982; 144: 313–316.
Ebbehoj N, Borly L, Masden P, Matzen P. Pancreatic tissue fluid pressure during drainage operations for chronic pancreatitis. Scand J Gastroenterol 1990; 25: 1041–1045.
Bradley EL. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg 1987; 153: 207–213.
Dohmoto M, Rupp K. Endoscopic drainage of pancreatic pseudocysts. Surg Endosc 1992; 6: 118–124.
Bejanin H, Liguory C, InK O, Fritsch J, Choury AD, Lefebvre JF, Vilgrain V, Etienne JP. Drainage endoscopique des pseudokystes du pancréas. Gastroenterol Clin Biol 1993; 17: 804–810.
Smits ME, Rauws EA, Tytgat GN, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 202–207.
Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP. Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 208–213.
Binmoeller KF, Jue P, Seifert H, Izbicki J, Soehendra N. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long term results. Endoscopy 1995; 27: 638–644.
Laugier R, Renou C. Endoscopic ductal drainage may avoid resective surgery in painful chronic pancreatitis without large ductal dilatation. Intl J Pancreatol 1998; 23: 145–152.
Cremer M, Devière J, Delhaye M, Baize M, Vandermeeren A. Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy 1991; 23: 171–176.
Ponchon T, Bory RM, Hedelius F, Roubein LD, Paliard P, Napoleon B, Chavaillon A. Endoscopic stenting for pain relief in chronic pancreatitis results of a standardized protocol. Gastrointest Endosc 1995; 45: 452–456.
Laugier R. Dynamic endoscopic manometry of the responses to secretine in patients with chronic pancreatitis. Endoscopy 1994; 26: 222–227.
Laugier R, Gérolami R, Renou C. Sphineter of oddimanometry. Paradoxical response to secretin but not to CCK in alcoholic patients with no pancreatic disease. Intl J Pancreatol 1998; 23: 107–114.
Tanaka M, Ikeda S. Sphincter of Oddi manometry: comparison of microtransducer and perfusion methods. Endoscopy 1998; 20: 184–188.
Tanaka M, Ikeda S, Nakayama F. Nonoperative measurement of pancreatic and common bile duct pressures with a microtransducer catheter and effects of duodenoscopic sphincterotomy. Dig Dis Sci 1981; 26: 545–552.
Dreiling DA, Greestein A, Bordalo O. The hypersecretory states of the pancreas. Am J Gastroenterol 1973; 59: 505–511.
Okazaki K, Yamamoto Y, Ito K. Endoscopic measurement of papillary sphincter zone and pancreatic main duct pressure in patients with chronic pancreatitis. Gastroenterology 1986; 91: 409–418.
Slaff J, Wolfe M, Toskes P. Elevated fasting cholecystokinin levels in pancreatic exocrine impairment: evidence to support feedback regulation. J Lab Clin Med 1985; 105: 282–285.
Bockman D, Buchler M, Malfertheiner P, Beger H. Analysis of nerves in chronic pancreatitis. Gastroenterology 1988;
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Renou, C., Grandval, P., Ville, E. et al. Endoscopic treatment of the main pancreatic duct. International Journal of Pancreatology 27, 143–149 (2000). https://doi.org/10.1385/IJGC:27:2:143
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1385/IJGC:27:2:143