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Endoscopic drainage in benign pancreatic disease: immediate and medium term outcome
L E Hammarström1, H Stridbeck, I Ihse
1Department of Surgery, University Hospital, Lund, Sweden.
Objective:
To elucidate further the role of endoscopy in the treatment of benign pancreatic disease.
Design:
Retrospective study.
Setting:
University hospital, Sweden.
Subjects:
136 of 319 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for known or suspected pancreatic disease had abnormal findings at duodenoscopy or ductography, or both. In 28 patients endoscopic treatment was considered because of recurrent acute pancreatitis (n = 6), chronic pancreatitis (n = 5), pancreatic pain syndrome (n = 5), pancreatic fistula with ascites (n = 1), and pseudocyst (n = 1), or appreciable biliary obstruction from chronic pancreatitis (n = 10).
Interventions:
Pancreatic duct drainage was attempted in 18 patients and successful in 13 (72%). Endoscopic sphincterotomy (EST) alone was done in 7/13 patients and an endoprosthesis (stent) was placed in 6/13. Bile duct drainage was attempted and successful in 10 patients by EST together with dilatation with (n = 6) or without (n = 4) simultaneous placement of a stent.
Main Outcome Measures:
Relief of pain and cholestasis.
Results:
Immediate (1-30 days after initial treatment) and medium term (median 48 months after initial treatment) outcome after pancreatic duct drainage was excellent (no pain) or good (occasional mild pain) in 62% (8/13) and 67% (8/12) of the patients, respectively. Complications of the endoscopic procedure were encountered in four patients (31%) and comprised infection with abscess formation (n = 1), repeated stent clogging (n = 1) or stent migration (n = 2). Surgery was subsequently required in three patients (23%) because of intraabdominal abscess (n = 1), recurrent pain (n = 1), or no pain relief (n = 1). At medium term follow-up (median 68 months) after biliary drainage 7/10 patients had liver function tests within the reference ranges. Only two patients required subsequent biliodigestive shunts 7 and 13 months after EST, respectively.
Conclusion:
Our findings favour endoscopic drainage as a safe and effective method for temporary and medium term relief of pain and biliary obstruction in selected patients with benign pancreatic disease.