Kwon CI et al, 2017: Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis.
Kwon CI, Gromski MA, Sherman S, El Hajj II, Easler JJ, Watkins J, McHenry L, Lehman GA, Fogel EL.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
Kwon CI, Gromski MA, Sherman S, El Hajj II, Easler JJ, Watkins J, McHenry L, Lehman GA, Fogel EL.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA.
Abstract
Background and study aims: Complete 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 methods: 16 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.
Results: Among 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.
Conclusions: In 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.
Endoscopy. 2017 Feb 15. doi: 10.1055/s-0042-120996. [Epub ahead of print]. FREE ARTICLE
Comments 1
Reviews on the treatment of pancreatic pathologies with ESWL get significant visits of the blog. We have therefore included this article although it only deals with a few failures of this procedure. ”... this is the first report of the DPD (dorsal pancreatic duct) bypass method with pancreatic duct stenting in CCP (chronic calcific pancreatitis) with subsequent clinical improvement.”