title: Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis.
abstract: Background and study aimsComplete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD).Patients and methods16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period.ResultsAmong 16 patients meeting entry criteria, 10 (62.5 %) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75 %). Among these responders, 10 patients (83.3 %) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7 %) were able to discontinue their daily analgesics.ConclusionsIn selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail.
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Chang-Il
authors.initials: CI
authors.lastname: Kwon
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gromski
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Easler
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: James
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D002137:Calculi / Q000150:complications / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D015607:Stents