7246 The usefulness of endoscopic pancreatic stenting without sphincterotomy or pancreatic sphincterotomy in patients with chronic pancreatitis

Background/Aim: Endoscopic pancreatic stenting is performed to reduce pancreatic intraductal pressure and/or to release stricture of the pancreatic duct. However, endoscopic sphincterotomy(EST) or endoscopic pancreatic sphincterotomy(EPST) as a pretreatment of stenting, may cause bleeding, perforation and pancreatitis. Furthermore, EST/EPST may cause retrograde infection of the bile and pancreatic ducts. To establish a more convenient and safer method of endoscopic pancreatic stenting, we have prospectively performed stenting without EST or EPST. Methods: From Jan. 1991 to Oct. 1999, we performed pancreatic stenting in 20 patients (aged 21-80, median=50, M:F=18:2). 15 patients consumed alcohol regularly, and 17 patients had pancreatolithiasis. We used polyethylene tubes(5Fr-10Fr) to create stents. Stenting was performed in the following cases: 1)abdominal and back pain caused by stricture of the pancreatic duct or increased intrapancreatic ductal pressure due to pancreatolithiasis (9 cases), 2)an adjuvant therapy for extracorporeal shock wave lithotripsy(ESWL) for pancreatolithiasis (6 cases), 3)obstructive acute suppurative pancreatitis due to stricture or stones (3 cases), and 4)intractable pancreatic pseudocysts that connected with the pancreatic duct (2 cases). Results: Pancreatic stenting was successful in 19 of 20 cases (95%) without EST or EPST (except 1 case, EPST had been previously performed). We placed stent through major papillae in 14 (5Fr-7Fr:2, 8Fr:8, 10Fr:4) cases, and through minor papillae in 5 (7Fr:1, 10Fr:4) cases. The periods of stenting were 10 to 780 days (median=78). Symptoms disappeared or improved in 8 of 9 cases with pain; discharge of stone fragments was hastened in 100% of ESWL cases; acute pancreatitis was improved in 100% of cases, and pseudocysts reduced in 1 out of 2 cases. Therefore, stenting effectiveness was 90%. Complications included occlusion of stents (2 cases), migration into the pancreatic duct (1 case) and transient hepatic dysfunction (1 case). Conclusions: EST or EPST is not necessary for endoscopic pancreatic stenting in most patients. Pancreatic stenting may be a useful therapy to improve symptoms associated with chronic pancreatitis.