Multiple Stenting of Refractory Pancreatic Duct Strictures in Severe Chronic Pancreatitis: Long-term Results

Costamagna, Guido; Bulajić, Milutin; Tringali, Andrea; Pandolfi, M.; Gabbrielli, Armando; Spada, C.; Petruzziello, Lucio; Familiari, Pietro; Mutignani, Massimiliano

doi:10.1055/s-2005-921069

Cited by 218 publications

(150 citation statements)

References 10 publications

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“…After stent removal, stricture resolution was observed in 95% of 17 patients. After a mean of 38 months follow-up, 84% of patients remained pain-free [198]. Asymptomatic common bile duct dilation in patients with normal liver function tests may be detected by imaging techniques (MRCP, CT) in patients with chronic pancreatitis [201][202][203][204].…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

“…Long-term pain relief was experienced by two-thirds of patients after 12 months stenting, though resolution of the stricture was observed in a minority of patients [176,193]. Calibration of a single distal main pancreatic duct stricture with multiple stents insertion (range 2−4 large-bore stents for 6 months) is a promising approach recently described [198]. After stent removal, stricture resolution was observed in 95% of 17 patients.…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

“…Early removal of a pancreatic stent can be considered if it has no effect on pain. Currently there are two strategies in pancreatic stenting: either removing the pancreatic stent after a period of 6−12 months irrespective of the resolution of the stricture of the main pancreatic duct or substitution of pancreatic stents until stricture disappearance [175,176,[193][194][195][196][197][198][199][200]. Long-term pain relief was experienced by two-thirds of patients after 12 months stenting, though resolution of the stricture was observed in a minority of patients [176,193].…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

See 2 more Smart Citations

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

162

111

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

See 1 more Smart Citation

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

162

111

View full text Add to dashboard Cite

show abstract

“…Although the approach of multiple stents for PD strictures seems promising [40][41][42] , to our knowledge, at the time of writing, there have been no studies comparing single and multiple stenting procedures for PD strictures caused by CP.…”

Section: Pancreatic Stricturesmentioning

confidence: 99%

Endoscopic management of chronic pancreatitis

Oza

Kahaleh²

2013

WJGE

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Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

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“…A multiple stenting approach was proposed by Costamagna et al [20] in a subset of patients with refractory dominant MPD strictures: they reported lasting stricture dilation in 84% of their patients at 38-mo follow-up. Although placing a mean of three stents within pancreatic strictures may be difficult, this approach appears feasible and safe and could in fact dramatically reduce the need for surgery in the majority of patients with chronic obstructive pancreatitis ( Figure 6).…”

Section: Chronic Pancreatitismentioning

confidence: 99%

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

Alberto¹,

Testoni²

2007

WJG

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The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS), or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis, and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

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Multiple Stenting of Refractory Pancreatic Duct Strictures in Severe Chronic Pancreatitis: Long-term Results

Abstract: Endoscopic multiple stenting of dominant pancreatic duct strictures in chronic pancreatitis is a feasible and safe technique. Multiple pancreatic stenting is promising in obtaining persistent stricture dilation on long-term follow-up in the setting of severe chronic pancreatitis.

Cited by 218 publications

References 10 publications

Italian consensus guidelines for chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

Endoscopic management of chronic pancreatitis

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

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