ENDOSCOPIC PANCREATIC SPHINCTEROTOMY - INDICATIONS, OUTCOME, AND A SAFE STENTLESS TECHNIQUE

Background: Endoscopic pancreatic sphincterotomy is less widely practi ced than biliary sphincterotomy, in part because of the lack of firm d ata regarding its indications and safety. In addition, recent reports of ductal and parenchymal changes occurring after pancreatic stenting raise concerns about the standard practice of stent placement at the t ime of pancreatic sphincterotomy. We report our experience with pancre atic sphincterotomy and describe the use of a technique involving over night nasopancreatic drainage rather than stenting. Methods: We review ed the records of the 164 pancreatic sphincterotomies performed on 160 patients at our institution between January 1, 1991, and October 1, 1 996, comparing procedures done with overnight nasopancreatic catheter placement with those done with stenting or no drainage. We also examin ed the long-term clinical outcome of patients after pancreatic sphinct erotomy. Results: Of the 164 sphincterotomies, 98 were done with overn ight nasopancreatic drainage, 50 with stent placement, and 16 with no drainage. Complications (all pancreatitis) were significantly more fre quent in the group with no drainage (12.5%) as compared with those wit h drainage (0.7%); p < 0.003. Nasopancreatic drainage was as safe as s tent placement, with no complications after 98 procedures. Pancreatic sphincterotomy was effective when used as primary therapy, with 64% of patients so treated experiencing complete and long-lasting resolution of symptoms after the procedure. Conclusions: Pancreatic sphincteroto my is safe and effective, although pancreatic drainage is required to reduce the incidence of pancreatitis. Overnight nasopancreatic drainag e is the method of choice, as it carries as low a complication rate as stent placement, but without the need for a repeat procedure, and pre sumably without the risk of ductal and parenchymal damage.