[Possibilities and limitations of retrograde transpapillary stenting of the main pancreatic duct in the treatment of chronic pancreatitis and its complications].

UNLABELLED: For the last years the role of endoscopic pancreatic stenting in the treatment of chronic pancreatitis and its complica- tions has significantly increased.

MATERIALS AND

METHODS

In the clinic of abdominal surgery and endoscopy of Pirogov RNRMU based on the University Hospital 31 for the period from 01.1998 to 01.2014 Wirsung duct occlusion, which developed on the background of CP was the cause of performing of 215 endoscopic procedures in 95 patients: 34 (35.8%) women and 61 (64.2%) men. Mean age 49.8 ± 11.7 years. Study group consisted of 52 (54.7%) patients with strictures of MPD and 43 (45.3%) with pancreatic fistulas. We tried to perform pancreatic stenting in all the cases, as a method of treatment of pathological changes in the pancreatic ductal system.

RESULTS

Endoscopic stenting was successfully performed in 64 cases (67.4%), while in 45 (70.3%) cases, this intervention was the definitive method of treatment. Temporary Wirsung duct stenting was performed in 19 (29.7%) cases in which endoscopic retrograde step interven- tions were training to perform surgery. It is significant that the main causes of the technical impossibility of pancreatic stenting was the complete dissociation of Wirsung duct (8), distal localization of occlusive lesions (13), presence of severe angulation in stenotic changes (20) and the length of the scar stricture of the MPD more than 1 cm (17) and particularly a combination of several factors. Clinically significant complications after endoscopic interventions in our study occurred in 6 (2.8%) cases. Lethal outcome occurred in one patient (0.5%).

CONCLUSION

According to the results of our study pancreatic stenting was technically feasible in 67.4% of all cases. At the same time, endoscopic correction, if the possibility of its technical implementation, may be the final method of treatment in 70.3% cases. In this endoscopic pancreatic stenting has a low complication rate (2.8%) and mortality (0.5%). The main reasons for the failures and limitations of endoscopic stage treatment is a combination of factors: complete dissociation of the MPD, distal location of the Wirsung duct strictures with severe angulation in this area and a large length of strictures.