Abstract
The Management for Chronic Pancreatitis and Pancreatic Duct Stones
Dr Kiyohito Tanaka
Vice Director,
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Japan
Introduction:
In recent years, non-laparoscopic approach such as oral dissolution therapy for pancreatic stones, EPDL (endoscopic pancreatic duct lithotomy), and ESWL (extracorporeal shockwave lithotripsy) has been put to practical use. Especially EPDL with duodenal endoscope was extremely useful with quick-acting, certainty, and non-invasiveness in itself, and was located as the method corresponding to the surgical operation. And the pancreatic ductal drainage such as balloon dilatation and stenting for stricture pf pancreatic duct, have been developed as procedure before and after treatment, usefulness of EPDL has come to be evaluated more and higher. In this study, we evaluated EPDL to pancreatic stones, and refer the point of contact of ESWL and drainage for pancreatic duct as the auxiliary method.
Materials and Methods:
The main pancreatic ductal stone over 90cases with symptoms performed EPDL in our hospital form June, 1983. In 93 cases were operated EST beforehand as basic procedure, and in only one case with divism of pancreatic duct, endoscopic balloon dilatation of minor papilla was performed. Moreover, in 50 cases with comparatively large stones, ESWL was performed before EPDL.
Results:
In all 93 cases, EST was succeeded. In 72 cases , complete removal and almost complete removal of pancreatic stones were succeeded. The details of lithotripsy were 8 cases in natural discharge without removal procedures, 12 cases of removing by the basket catheter, and 42 cases of removing by the basket catheter undergone ESWL, and 3case of basket removal with endoscopic balloon dilatation of minor papilla. Complications in EPDL were 2cases of acute pancreatitis, however all cases were slight illness, additionally, other complications was not admitted such as the hemorrhages. In 20case of incomplete removal for pancreatic stones, 9 cases were performed surgical operation. In the 9cases enforced surgical therapy, 3 cases before the introduction of ESWL, 2 cases were the cases of focal pancreatitis with repeating the attack of acute pancreatitis, 4 cases accompany with pseudo cyst. In all cases of complete removal of pancreatic stones by EPDL, the symptoms admitted before treatment such as, epigastralgia, back pain, and tenderness disappeared. Pancreatic enzyme in serum such as Amylase, Lipase, Elastase-I were improved in 90%. Moreover, 47 cases in 50 cases with stenosis of distal main pancreatic duct, stricture was improved, and the effect of endoscope treatment was confirmed. In observation of 51 cases with successful of removal of the stones (longest observation period was ten years. Average observation period was 2.5 years), in 12 cases (23%), recurrent of the stones was appeared. 11 cases in these recurrent cases were accompanied with stricture of the main pancreatic duct. 11 cases with stricture were performed with re-EPDL after drainage. The stricture of main pancreatic duct was improved after drainage; however recurrence of the stricture was occurred in 78% cases.
Summary and Conclusions:
EPDL is extremely useful as the first selection of the therapeutic procedure, which takes the place of the surgical laparotomy approach. However, the problem like as indication and limit, period of treatment, measure against recurrence, long term prognosis, which should still be solved remains. Therefore, it is thought that it is necessary to make an effort to continue the study by which the case was piled up in the future, and to become a safe, reliable treatment method.
