Wall stent-enhanced lateral pancreaticojejunostomy for small-duct pancreatitis

James A. Madura, David F. Canal, Glen A. Lehman, Michael B. Farnell, Richard A. Prinz, Theodore X. O'Connell, Merrill T. Dayton

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Abstract

Hypothesis: The purpose of this study was to see if a small (<7 mm) pancreatic duct could be dilated to an acceptable diameter, allowing lateral pancreaticojejunostomy to decompress the pancreatic duct and relieve pain, while preserving pancreatic endocrine and exocrine function. Design: Patients with chronic pancreatitis who had a small main pancreatic duct underwent progressive transampullary dilation of the duct and subsequent placement of an expandable metallic wall stent (wallstent; Boston Scientific Microvasive Division, Natick, Mass). Approximately 14 days later, a lateral pancreaticojejunostomy was done. Setting: A 400-bed university referral center hospital in an urban setting. Patients: Thirty-five patients were selected from a large group with chronic pancreatitis. Thirty-one had pancreas divisum. All patients had undergone transendoscopic sphincterotomies and stenting before being accepted into the study. All had endoscopic retrograde cholangiopancreatography - proven chronic pancreatitis, and all ducts were observed to be 7 mm or smaller. Interventions: Patients were selected after endoscopic sphincterotomy and stenting failed. Progressive transendoscopic duct dilation with plastic stents was carried out, and a 10-mm expandable metallic wall stent was placed prior to surgical decompression. Lateral pancreaticojejunostomy was performed. Main Outcome Measures: Patients were observed for pain relief, postoperative symptoms, analgesic use, glucose intolerance, and quality of life. All patients were seen or contacted by telephone, and their results were recorded. Results: There were no operative deaths, but 26% of patients had complications. Seventy-one percent of patients reported that their pain was better than preoperatively. Three patients had subsequent pancreatic surgery. No new cases of diabetes occurred except in the 2 patients who underwent total pancreatectomy. Conclusions: In general, most patients feel that their lives were improved by the procedure. A quarter of the patients no longer take narcotics, and many have been able to resume a relatively normal lifestyle. Although this procedure is not a panacea for all patients with chronic pancreatitis and a nondilated duct, it is a reasonable alternative to resection.

Original languageEnglish (US)
Pages (from-to)644-650
Number of pages7
JournalArchives of Surgery
Volume138
Issue number6
DOIs
StatePublished - Jun 1 2003

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ASJC Scopus subject areas

  • Surgery

Cite this

Madura, J. A., Canal, D. F., Lehman, G. A., Farnell, M. B., Prinz, R. A., O'Connell, T. X., & Dayton, M. T. (2003). Wall stent-enhanced lateral pancreaticojejunostomy for small-duct pancreatitis. Archives of Surgery, 138(6), 644-650. https://doi.org/10.1001/archsurg.138.6.644