Endoscopic treatment of chronic pancreatitis |
| |
| Authors: | Bartoli Eric Delcenserie Richard Yzet Thierry Brazier Franck Geslin Guillaume Regimbeau Jean-Marc Dupas Jean-Louis |
| |
| Affiliation: | 1. Service d’Hépato-Gastroentérologie, CHU Hôpital Nord, 80054 Amiens Cedex;2. Service de Radiologie, CHU Hôpital Nord, 80054 Amiens Cedex;3. Service de Chirurgie Viscérale et Digestive, CHU Hôpital Nord, 80054 Amiens Cedex;1. Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medical, Baltimore, MD, USA;5. Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medical, Baltimore, MD, USA;6. Division of Abdominal Imaging, Department of Radiology, Johns Hopkins University School of Medical, Baltimore, MD, USA;7. The Comprehensive Transplantation Unit, Johns Hopkins University School of Medical, Baltimore, MD, USA;1. Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA;2. Weill Cornell Medicine, New York, New York USA;3. Yale Harvey Cushing/John Hay Whitney Medical Library, New Haven, Connecticut, USA;4. Department of Medicine, VA Connecticut Healthcare System, Connecticut, USA;1. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark;2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;3. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark;4. Centre for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark;1. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;2. Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;1. Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health, New Haven, Connecticut;3. Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland;4. Department of Internal Medicine, Yale Waterbury Internal Medicine Program, Yale School of Medicine, New Haven, Connecticut;5. Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut;1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan;2. Department of Gastroenterology, Sendai Medical Center, Sendai, Miyagi, Japan;3. Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan;4. Molecular Epidemiology, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan |
| |
| Abstract: | OBJECTIVES: Endoscopy offers an alternative to surgery for the treatment of ductal complications in patients with chronic pancreatitis. The aim of this study was to evaluate the efficacy of endoscopic treatment on pain, cholestasis and pseudocysts in these patients. PATIENTS AND METHODS: Thirty-nine patients (37 M, 2 F, mean age 44), were included in the study. All patients had at least one of the following criteria demonstrated by imaging tests: dilatation of the main pancreatic duct (MPD) with or without stricture (N = 13), bile duct stricture (N = 12), or pancreatic pseudocyst (N = 14) with pancreatic duct stricture (N = 11) or biliary stricture (N = 3). Pancreatic or biliary sphincterotomy, insertion of pancreatic or biliary stent, pseudocyst drainage with stent placement were performed according to ductal abnormalities. Patients were evaluated early and followed up during the stenting period, and after stent removal. RESULTS: Patients underwent a median of 3.5 endoscopic procedures with an interval of 2.2 months between 2 stenting sessions. A pancreatic or biliary stent was inserted in 25 patients with ductal abnormalities and in 11 patients with pseudocysts. Endoscopic pseudocyst drainage was performed in 6 cases. The mean stenting time was 6 months (range: 3-21). Mean follow-up after stent removal was 9.7 (2-48) months. Complications of endoscopic treatment were encountered in 7% of patients with no deaths. Pain relief was achieved after the first endoscopic procedure and during the overall stenting period in all patients. Recurrence of pain was observed after stent removal in 5/11 patients, requiring surgery in 4. Cholestasis decreased and biochemical values normalized within one month after biliary stenting. Recurrence of cholestasis was observed early after stent removal in 4/9 patients who required complementary surgical treatment. No recurrence of pancreatic pseudocyst was observed after endoscopic drainage and stent removal during the follow-up period. CONCLUSIONS: Endoscopic treatment of pain from pancreatic pseudocysts or ductal strictures is effective in the short-term and in the period of ductal stenting. However, the optimal duration of the latter remains to be determined. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect PubMed 等数据库收录！ |
|
