Outcomes after clearance of pancreatic stones with or without pancreatic stenting.
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.
Sasahira
Naoki
N
Department of Gastroenterology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Tada
Minoru
M
Isayama
Hiroyuki
H
Hirano
Kenji
K
Nakai
Yousuke
Y
Yamamoto
Natsuyo
N
Tsujino
Takeshi
T
Toda
Nobuo
N
Komatsu
Yutaka
Y
Yoshida
Haruhiko
H
Kawabe
Takao
T
Omata
Masao
M
D000328:Adult; D000368:Aged; D002137:Calculi / Q000150:complications / Q000628:therapy*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000628:therapy*; D010183:Pancreatic Ducts / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000209:etiology; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome