Endoscopic Duct Obstruction in Chronic Pancreatitis

Abstract

Ligation of Wirsung's duct or obstruction with a glue may be an alternative to pancreatectomy in patients with intractable pain due to chronic relapsing pancreatitis. In 10 patients obstruction of Wirsung's duct was performed via endoscopic retrograde instillation of an alcoholic aminoacid solution into the ductal system. All patients became free of symptoms within one week; no complications were seen. Long-term follow-up data, however, suggest that clinical improvement may be persistent in only about 50 per cent of the patients. Further data are necessary before endoscopic obstruction of Wirsung's duct can be recommended as a conservative method in the treatment of chronic pancreatitis.

Endoluminal radiofrequency ablation of the main pancreatic duct is a secure and effective method to produce pancreatic atrophy and to achieve stump closure

“…1B), as described in Alfieri et al . (2018) 9 . During application the catheter was gently pulled back in order to fill the entire duct with glue.…”

“…This procedure has been extensively studied in the experimental setting as a model of expansion of β cell or mass-β-cell neogenesis and is also currently being studied as a novel therapy for diabetes 2–8 , usually by ligation of the pancreatic duct. Clinical studies involving intraductal injection of hardening glue have been carried out in two scenarios: (1) as a system of abolition of the pancreatic secretion and pain in chronic pancreatitis 9,10 , and (2) as a method of managing the pancreatic stump after pancreaticoduodenectomy (PD), usually after removal of the pancreatic tumor in the head of the pancreas 11–14 . However, this procedure has never found much acceptance by clinicians because of the high risk of failure in the form of recanalization of the main pancreatic duct (first indication) or fistula formation (second indication) which can affect more than 50% of the patients 15,16 .…”

Pain Relief and Functional Recovery after Endoscopic Interventions for Chronic Pancreatitis

“…To achieve the 'burned-out' state of chronic pancreatitis, occlusion of the pancreatic duct by ligation (23), with Neopren (24) or Ethibloc (25), has been proposed during Whipple's procedure (25), transplantation of the pancreas (24) or without surgery via endoscopic canulation of the papilla of Vater (26). It has been stated that the number of relapses diminishes after these procedures, but functional changes of the pancreas have not been examined except in one preliminary study (27).…”

Απολινωση Παγκρεατικου Πορου Σε Συγκριση Με Εμφραξη Του Με Προλαμινη: Πειραματικη Μελετη Σε Σκυλους

“…Θα πρέπει επίσης να σημειωθεί ότι η ροή της λέμφου μέσα στα παγκρεατικά λεμφαγγεία κατευθύνεται, με τη βοήθεια βαλβίδων, πάντοτε από το πάγκρεας προς το δωδεκαδάκτυλο και ποτέ αντίθετα. 6 63 φυσιολογικές τιμές και παρέμεναν εντός φυσιολογικών ορίων σ' όλες τις με τρήσεις που ακολουθούν μέχρι τη θυσία των πειραματόζωων (σχ. 9 και 10, πιν.…”