Endoscopic pancreatic-stent placement and sphincterotomy for relief of pain in tropical pancreatitis: results of a 1-year follow-up.
BACKGROUND
Tropical chronic pancreatitis frequently presents with intractable abdominal pain. Surgical treatment has its own morbidity and mortality, and long-term results may not be satisfactory.


OBJECTIVE
To analyze the results of endoscopic pancreatic-stent placement and sphincterotomy for the pain of tropical pancreatitis.


METHODS
Retrospective review.


METHODS
Tertiary-referral hospital.


METHODS
Twenty-four patients with tropical pancreatitis with severe, persistent pain not responding to standard medical therapy over a period of 30 months beginning January 1998.


METHODS
Stent placement of the pancreatic duct, along with sphincterotomy.


METHODS
At least 80% global improvement in pain as reported by the patient during follow-up after the procedure.


RESULTS
In the 19 evaluable patients, the intended procedure, pancreatic stent placement along with sphincterotomy, was successful in 14 (73.7%); 3 others had sphincterotomy alone. Over a follow-up period of 6 to 38 months, 12 of the 14 patients (85.7%) who underwent stent placement plus sphincterotomy and 2 of the 3 patients who had sphincterotomy alone responded. Twelve of these were completely free of pain, and the remaining 2 patients had mild infrequent pain that occurred once in 2 to 4 months, lasting a few hours at a time and never needing hospitalization. The only major complication was the development of pancreatic sepsis, which required stent removal in 1 patient. Eight patients were stent free at the end of 6 months, and, over a further follow-up of 6 to 20 months, the pattern of pain relief persisted in them.


CONCLUSIONS
The retrospective nature of the study, the limited numbers studied, and the lack of assessment of pain on a standard visual analog scale.


CONCLUSIONS
Stent placement of the pancreatic duct with pancreatic sphincterotomy constitutes an important nonsurgical therapeutic option for the intractable pain of tropical pancreatitis.
Pai
C Ganesh
CG
Department of Gastroenterology, Kasturba Medical College, Manipal, India.
Alvares
Jose Filipe
JF
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014329:Tropical Climate