Introduction: Pancreatic duct stenting is an established procedure for chronic pancreatitis with dominant stricture at the head region. However, stent-induced lesions, dislocation, occlusion, even sepsis can occur.
Method: During a 6 years period 56 pancreatic stentings in 25 patients were performed in our institution. In 17 cases when multiple stent placement seemed feasible in one setting or after some days of nasopancreatic lavage we used 2–3 10 French teflon plastic stents (MTW) to calibrate the pancreatic stenosis to achieve permanent resolution of the stricture. Mean age of the 3 females and 22 males was 56.4 (ranges 42–78)yrs. In 16 cases 1 stent (Group 1), in 11 cases 2 stents, in 6 cases 3 stents (Group 2) were placed over 2 guide wires after pancreatic papillotomy and progressive dilatation of the dominant stricture with 6–10 French dilator. In 8 patients ESWL and/or citrate lavage (18 cases) was performed meantime. We regularly followed-up the patients 2 monthly or when the pain relapsed with ultrasonography and amylase measurement.
Results: No complication occurred at stenting. Stents remained in place for 3.3 months and 5.5 months (range 1–18) in Group 1 and Group 2, respectively and removed as indicated by US and the typical postprandial pain with/without amylase elevation. Relapse free follow-up occurred for 31.6 and 41.6 months (range 8–80) in Group 1 and Group 2, respectively until now. Increasing the stent number prolonged the relapse free period in 2 pts. Relapses (7–7 cases) were provoked by alcohol, smoking and heavy meals and treated mainly by multiple stenting (6 cases) or operation (2 patients).
Conclusion: Multiple pancreatic stents increase the relapse free follow-up period after endotherapy, however, alcohol intake and smoking have to be prevented. A randomized, well controlled study is indicated to definitely prove the advantage of multiple pancreatic stents for calibrating the pancreatic strictures.
