Dilation of refractory pancreatic duct strictures: the turn of the screw.

BACKGROUND

Endoscopic pancreatic ductal drainage may improve pain from chronic pancreatitis but stricture dilation may be technically difficult.

METHODS

Eight patients with refractory pancreatic strictures had dilation with a Soehendra stent retriever. Each had sphincterotomy, guidewire placement, stent retriever dilation to 7F to 10F, and stenting for 6 to 12 months.

RESULTS

All procedures were successful and 1 (13%) was complicated by mild pancreatitis. The mean follow-up was 21 months. Each patient had substantial pain relief with patent stents in place, but 7 (88%) relapsed with stent occlusion or removal. Four (50%) patients underwent surgery with excellent results. However, endoscopic therapy alone resulted in just modest benefits or pain recurrence in 3 (38%) and persistent relief in only 1 (13%).

CONCLUSIONS

The Soehendra stent retriever is effective as a dilating device for pancreatic strictures resistant to conventional dilation. However, substantial symptom relief may persist only while patent stents are in place.