Long-Term Outcome after Pancreatic Stenting in Severe Chronic Pancreatitis

Background and Study Aims: Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-term outcomes after stent removal have not been fully evaluated.
Patients and Methods: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated for pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged ”on demand” (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectively assessed as potential predictors of re-stenting.
Results: The etiology of the chronic pancreatitis was alcoholic (77 %), idiopathic (18 %), or hereditary (5 %). Patients were followed up for a median period of 69 months (range 14 - 163 months) after study entry, including a median period of 27 months (range 12 - 126 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 - 134 months). After attempted definitive stent removal, 30 patients (30 %) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1 - 12 months), while in 70 patients (70 %) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had required re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002).
Conclusions: The majority (70 %) of patients with severe chronic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However, a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.

References

• 1 Huibregtse K, Schneider B, Vrij A A, Tytgat G N. Endoscopic pancreatic drainage in chronic pancreatitis.  Gastrointest Endosc. 1988;  34 9-15
• 2 Cremer M, Devière J, Delhaye M. et al . Stenting in severe chronic pancreatitis: results of medium-term follow-up in 76 patients.  Endoscopy. 1991;  23 171-176
• 3 Binmoeller K F, Jue P, Seifert H. et al . Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results.  Endoscopy. 1995;  27 638-644
• 4 Ponchon T, Bory R M, Hedelius F. et al . Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol.  Gastrointest Endosc. 1995;  42 452-456
• 5 Smits M E, Badiga S M, Rauws E A. et al . Long-term results of pancreatic stents in chronic pancreatitis.  Gastrointest Endosc. 1995;  42 461-467
• 6 Devière J, Delhaye M, Cremer M. Pancreatic duct stones management.  Gastrointest Endosc Clin N Am. 1998;  8 163-179
• 7 Delhaye M, Matos C, Devière J. Endoscopic management of chronic pancreatitis.  Gastrointest Endosc Clin N Am. 2003;  13 717-742
• 8 Cremer M, Toussaint J, Hermanus A. et al . Les pancréatites chroniques primitives: classification sur base de la pancréatographie endoscopique.  Acta Gastroenterol Belg. 1976;  39 522-546
• 9 Ammann R W, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis.  Gastroenterology. 1999;  116 1132-1140
• 10 Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis.  Endoscopy. 2003;  35 553-558
• 11 Rosch T, Daniel S, Scholz M. et al . Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up.  Endoscopy. 2002;  34 765-771
• 12 Neuhaus H. Therapeutic pancreatic endoscopy.  Endoscopy. 2004;  36 8-16
• 13 Barthet M. Traitement endoscopique de la pancréatite chronique.  Gastroenterol Clin Biol. 2002;  26 B130-B139
• 14 Boerma D, Huibregtse K, Gulik T M. et al . Long-term outcome of endoscopic stent placement for chronic pancreatitis associated with pancreas divisum.  Endoscopy. 2000;  32 452-456
• 15 Lehman G A, Sherman S. Diagnosis and therapy of pancreas divisum.  Gastrointest Endosc Clin N Am. 1998;  8 55-77
• 16 Talamini G, Bassi C, Falconi M. et al . Pain relapses in the first 10 years of chronic pancreatitis.  Am J Surg. 1996;  171 565-569