title: Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results.
abstract: OBJECTIVE
  Dominant pancreatic duct strictures located in the head of the pancreas in patients with severe chronic pancreatitis are often managed by endoscopic placement of a single plastic stent. Patients with refractory strictures after prolonged stenting require repeated stent replacement or surgical pancreaticojejunostomy. Placement of multiple plastic stents has proved effective in managing postoperative biliary strictures. The aim of this study was to investigate the feasibility, efficacy, and long-term results of multiple stenting of refractory pancreatic strictures in severe chronic pancreatitis.
  
  
  METHODS
  19 patients with severe chronic pancreatitis (16 men, three women; mean age 45 years) and with a single pancreatic stent through a refractory dominant stricture in the pancreatic head underwent the following protocol: (i) removal of the single pancreatic stent; (ii) balloon dilation of the stricture; (iii) insertion of the maximum number of stents allowed by the stricture tightness and the pancreatic duct diameter; and (iv) removal of stents after 6 to 12 months.
  
  
  RESULTS
  The median number of stents placed through the major or minor papilla was 3, with diameters ranging from 8.5 to 11.5 Fr and length from 4 to 7 cm. Only one patient (5.5 %) had persistent stricture after multiple stenting. During a mean follow-up of 38 months after removal, 84 % of patients were asymptomatic, and 10.5 % had symptomatic stricture recurrence. No major complications were recorded.
  
  
  CONCLUSIONS
  Endoscopic multiple stenting of dominant pancreatic duct strictures in chronic pancreatitis is a feasible and safe technique. Multiple pancreatic stenting is promising in obtaining persistent stricture dilation on long-term follow-up in the setting of severe chronic pancreatitis.
authors.affiliation: Digestive Endoscopy Unit, Catholic University of the Sacred Heart, A. Gemelli University Hospital, Largo A. Gemelli 8, 00168 Rome, Italy. gcostamagna@rm.unicatt.it
authors.forename: G
authors.initials: G
authors.lastname: Costamagna
authors.forename: M
authors.initials: M
authors.lastname: Bulajic
authors.forename: A
authors.initials: A
authors.lastname: Tringali
authors.forename: M
authors.initials: M
authors.lastname: Pandolfi
authors.forename: A
authors.initials: A
authors.lastname: Gabbrielli
authors.forename: C
authors.initials: C
authors.lastname: Spada
authors.forename: L
authors.initials: L
authors.lastname: Petruzziello
authors.forename: P
authors.initials: P
authors.lastname: Familiari
authors.forename: M
authors.initials: M
authors.lastname: Mutignani
mesh_terms: D000328:Adult; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D019233:Retreatment; D016717:Sphincterotomy, Endoscopic; D015607:Stents