Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis

Chang Il Kwon, Mark A. Gromski, Stuart Sherman, Ihab I. El Hajj, Jeffrey J. Easler, James Watkins, Lee McHenry, Glen Lehman, Evan Fogel

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5?%) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75?%). Among these responders, 10 patients (83.3?%) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7?%) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail.

Original languageEnglish (US)
JournalEndoscopy
DOIs
StateAccepted/In press - Sep 15 2016

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Chronic Pancreatitis
Drainage
Pancreatic Ducts
Lithotripsy
Pain
Calcific Pancreatitis
Pain Management
Stents
Analgesics
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis. / Kwon, Chang Il; Gromski, Mark A.; Sherman, Stuart; El Hajj, Ihab I.; Easler, Jeffrey J.; Watkins, James; McHenry, Lee; Lehman, Glen; Fogel, Evan.

In: Endoscopy, 15.09.2016.

Research output: Contribution to journalArticle

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abstract = "Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5?{\%}) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75?{\%}). Among these responders, 10 patients (83.3?{\%}) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7?{\%}) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail.",
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AU - Kwon, Chang Il

AU - Gromski, Mark A.

AU - Sherman, Stuart

AU - El Hajj, Ihab I.

AU - Easler, Jeffrey J.

AU - Watkins, James

AU - McHenry, Lee

AU - Lehman, Glen

AU - Fogel, Evan

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N2 - Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5?%) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75?%). Among these responders, 10 patients (83.3?%) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7?%) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail.

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