Pancreatic duct stents for "obstructive type" pain in pancreatic malignancy.
OBJECTIVE
Obstruction of the main pancreatic duct from malignancy with secondary ductal hypertension may be an important contributor to pain. The aim of our study was to determine the efficacy and safety of pancreatic stent placement for patients with "obstructive" pain due to pancreatic malignancy.


METHODS
Pancreatic duct stents were placed in 10 consecutive patients with malignant pancreatic duct obstruction and abdominal pain. Seven patients had "obstructive" type pain and three had chronic unremitting pain. Nine had primary pancreatic ductal adenocarcinoma and one had metastatic melanoma. There were eight women and two men. Mean age was 61 yr (range, 47-80 yr). All patients had dominant main pancreatic duct strictures with proximal dilation. Tumors were unresectable. All patients took potent analgesics before endoscopic stent therapy. Polyethylene pancreatic stents, 5- and 7-French, were successfully placed in seven patients, and self-expanding metallic stents were successfully placed in three patients.


RESULTS
There were no procedure-related complications. One patient required a single repeat examination to replace a migrated stent. Seven patients (75%) experienced a reduction in pain. Analgesia was no longer required in five (50%). Three patients who did not improve had chronic pain rather than "obstructive" pain.


CONCLUSIONS
Pancreatic stent placement for patients with "obstructive" pain secondary to a malignant pancreatic duct stricture appears to be safe and effective. It should be considered as a therapeutic option in these patients. It does not seem to be effective for chronic unremitting pain.
Tham
T C
TC
Division of Gastroenterology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Lichtenstein
D R
DR
Vandervoort
J
J
Wong
R C
RC
Slivka
A
A
Banks
P A
PA
Yim
H B
HB
Carr-Locke
D L
DL
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D020698:Duodenoscopes; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D010147:Pain Measurement; D010166:Palliative Care; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D011474:Prosthesis Design; D011859:Radiography; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy; D015607:Stents; D016896:Treatment Outcome