STENTING DOES NOT DECOMPRESS THE PANCREATIC DUCT AS EFFECTIVELY AS SURGERY IN EXPERIMENTAL CHRONIC-PANCREATITIS

Background. In humans with chronic pancreatitis (CP) pancreatic inters titial pressure (mi is elevated and pancreatic blood flow (PBF) is red uced. The efficacy of surgical decompression (SD) of the pancreatic du ct (ie, pancreaticojejunostomy) is believed to be due to its ability t o decrease IP and pancreatic vascular resistance (R-p), which increase s PBF: Pancreatic duct stenting (STE) also probably reduces IP and R-p which may explain its efficacy. The purpose of this study was to comp are the efficacy of SD with STE. Methods. CP in cats was created by na rrowing the main pancreatic duct. Six weeks later, CP and normal pancr eata were isolated and perfused ex vivo under basal conditions and aft er secretin stimulation. In normal and CP glands, IP and perfusion pre ssure were measured and R-p (U) was calculated. In two additional grou ps, the pancreatic duct was decompressed, either by stenting or by com plete transection of the duct with a longitudinal capsulotomy. Results ; In CP glands, IP and R-p were increased and secretory output was mar kedly reduced compared with the normal (0.65 +/- 0.30 mm Hg and 0.46 /- 0.04 U vs 3.90 +/- 0.80 mm Hg and 1.68 +/- 0.05 U; P <.05). Secreti n administration. (2 units) increased IP and R-p in CP glands (6.60 +/ - 1.10 mm Hg and 2.87 +/- 0.07 U; P <. 05), but these values did not c hange zn normal glands (0.81 +/- 0.20 and 0.53 +/- 0.03 U; NS). STE an d SD decreased IP and R-p in CP glands (2.20 +/- 0.20 to 1.0 +/- 0.40 mm Hg and 1.20 +/- 0.015 to 0.90 +/- 0.01 U, respectively; P <.05). Bo th methods prevented an increase of IP and R-p after secretin administ ration. IP and R-p decreased to a greater degree following SD, compare d with STE (P <.05). Conclusions. Both STE and SD decreased IP and R-p in this experimental model of CP. However; SD was significantly more effective than STE.