How are pancreatic duct strictures treated in patients with chronic pancreatitis?

Updated: Jul 15, 2019
  • Author: Jason L Huffman, MD; Chief Editor: BS Anand, MD  more...
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Answer

Suitable candidates for endoscopic therapy are patients with a dominant distal pancreatic stricture and upstream ductal dilatation. The procedure involves placing a guidewire through the stricture into the proximal duct, performing a pancreatic sphincterotomy, dilating the stricture, and placing a stent. While technical success is achieved in more than 90% of patients, nearly 20% will have a complication and less than two thirds of patients will benefit clinically. Pain relief correlates with a reduction in the diameter of the duct by more than 2mm. Patients with recurrent pancreatitis are more likely to benefit than are those with chronic daily pain.

The stricture rarely disappears, and the stent invariably clogs; therefore, repeated procedures are required to exchange the stent. Prolonged or inappropriate stenting can injure the pancreatic duct.


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