अग्नाशयी विकार और चिकित्सा
खुला एक्सेस

अमूर्त

आवर्ती क्रोनिक अग्नाशयशोथ के लिए एंडोस्कोपिक अग्नाशयी वाहिनी जल निकासी की रणनीति

Yoshiaki Kawaguchi, Masami Ogawa, Atsuko Maruno, Hiroki Yuhara, Hiroyuki Ito and Tetsuya Mine

Background: Methods of pancreatic duct (PD) drainage for recurrent chronic pancreatitis (CP) include endoscopic drainage combined with ESWL and surgical drainage. Although the endoscopic drainage has become widespread as this method is minimally invasive, there are cases in which stent removal is difficult. We retrospectively examined the current status of endoscopic drainage for recurrent CP at our hospital.

Methods: This study included 66 patients with recurrent CP (57 men and 9 women with a mean age of 59 ± 14 years, including 58 patients with alcoholic CP) who underwent endoscopic drainage between April 2006 and April 2012. Based on the initial images of PD, the patients were classified into the following types to compare their backgrounds and treatment processes: pancreatolithiasis (Stone) type (7 patients), PD stenosis (Stenosis) type (18), and Stone+Stenosis type (41). Moreover, patients with PD stent were divided into the following groups to compare their backgrounds and treatment processes: stent-removed groupand stent-maintained group in which the stent could not be removed.

Results: The procedure was successful in 61 patients (92%). Complete pain relief without analgesics was achieved in 60 patients (91%). The early complications were post-ERCP pancreatitis in 11 patients (2.7%, all mild in severity), and hemorrhage, basket impaction, and rupture of the pancreatic duct in 1 patient (0.5%) each. The late complications were pancreatic ductitis (0.7%), stent displacement (0.5%), stent migration (1.5%), and tear during removal of stent (1%). In Stone type patients, the mean number of procedural sessions and the number of patients who required at least 1 year of treatment were significantly smaller thanin those withPD stenosis (Stenosis type or Stone+Stenosis type) (P=0.0133 and P=0.0043, respectively). Patients with Stenosis type had a significantly smaller mean number of procedural sessions (P=0.0423) and a significantly lower incidence of complications (P=0.0366) than those with Stone+Stenosis type. Comparison between the stent-removed and stent-maintained groups revealed no significant differences in the mean number of procedural sessions, the number of patients with implantation of a stent with a diameter (thicker than 8.5-Fr), or the incidence of complications. In the stent-removed group, the number of patients who required at least 1 year of treatment was significantly smaller (P=0.0285).

Conclusions: In the short term, endoscopic stenting combined with ESWL was effective for pain relief, was associated with a low incidence of complications, and could be performed safely and effectively. For Stonetype recurrent CP, endoscopic therapy is highly effective and useful. On the other hand, from the long-term perspective, there are cases, especially among those with the Stone+Stenosis type, in which stent removal is difficult. Thus, surgical drainage should also be considered.