TREATMENT OF OBSTRUCTIVE PAIN BY ENDOSCOPIC DRAINAGE IN PATIENTS WITHPANCREATIC HEAD CARCINOMA

Obstruction of the main pancreatic duct with secondary upstream ductal hypertension is one cause of pain in patients with pancreatic cancer. Pancreatic endoscopic stenting and decompression of the pancreatic du ct have been effective in the treatment of pain secondary to chronic c alcifying pancreatitis and in one case of pancreatic cancer. We descri be eight patients with unresectable cancer of the pancreatic head asso ciated with upstream dilatation of the pancreatic duct and severe panc reatic ''obstructive''-type pain (correlation with meals and pain radi ation to the back) in which a pancreatic stent was inserted across the neoplastic stricture. No mortality was associated with the procedure. All patients but one were free of pain within 48 hours after endoscop ic pancreatic stenting, and all discontinued narcotics. Mean survival time was 165.5 days (range, 26 to 575 days). Six patients were still w ithout symptoms, whereas two had a painful relapse a few days before d eath. No clinical evidence of pancreatic clogged stent was observed du ring follow-up. Endoscopic pancreatic drainage is a safe and effective way of controlling cancer pain in selected cases and should be consid ered as a further therapeutic option in these patients.