ENDOSCOPIC PANCREATIC DRAINAGE IN CHRONIC-PANCREATITIS ASSOCIATED WITH DUCTAL STONES - LONG-TERM RESULTS

Background: In severe chronic pancreatitis associated with intraductal stones, therapeutic endoscopy aims to reduce increased intraductal pr essure by pancreatic sphincterotomy and stone clearance. Methods: Resu lts of treatment were evaluated in 70 new patients who underwent pancr eatic sphincterotomy and attempted stone removal. Technical results an d frequency of pain relief and recurrence are compared. Results: Compl ete ductal clearance of calculi was obtained in 50% of cases. Immediat e clinical improvement occurred in 95% of patients with painful attack s. No severe complications or mortality occurred. Fifty-four percent o f all patients with painful chronic pancreatitis did not experience an y pain recurrence within 2 years. Associations found to be statistical ly significant by multivariate analysis were ductal clearance and extr acorporeal shock wave lithotripsy, pain disappearance and ductal clear ance, pain recurrence and long evolution, and severe disease before tr eatment and presence of a ductal substenosis. Conclusions: In this sub set of patients our results indicate that the pain of chronic pancreat itis is mainly related to increased intraductal pressure. Endoscopic m anagement appears to be a safe, conservative, alternative to surgery. The best results are obtained when it is performed early in the course of calcifying chronic pancreatitis.