Endoscopic pancreatic duct stenting to treat pancreatic ascites

Background: Management of pancreatic ascites with conservative medical ther apy or surgery has met with limited success. Decompression of the pancreati c ductal system through transpapillary stent placement, an alternative stra tegy, has been reported in only a handful of cases of pancreatic ascites. Methods: We reviewed all cases from 1994 to 1997 in which patients with pan creatic ascites underwent an endoscopic retrograde pancreatogram documentin g pancreatic duct disruption with subsequent placement of a transpapillary pancreatic duct stent. Clinical end points were resolution of ascites and n eed for surgery. Results: There were 8 castes of pancreatic ascites in which a 5F or 7F tran spapillary pancreatic duct stent was placed as the initial drainage procedu re. Pancreatic ascites resolved in 7 of 8 patients (88%) within 6 weeks. As cites resolved in the eighth patient, a poor candidate for surgery followin g placement of a 5 mm expandable metallic pancreatic stent. No infections, alterations in ductal-morphology, or other complications related to stent p lacement were noted. There was no recurrence of pancreatic ascites or duct disruption at a mean follow-up of 14 months. Conclusions: Our experience doubles the number of reported cases in which t ranspapillary pancreatic stent placement safely obviated the need for surgi cal intervention in the setting of pancreatic ascites. This therapeutic end oscopic intervention should be seriously considered in the initial manageme nt of patients with pancreatic ascites.