Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: A prospective nonblinded randomized study using endoscopic stents

Background and Study Aims: Currently there is no available therapy to preve nt attacks of acute pancreatitis in patients with idiopathic recurrent panc reatitis (IRP). This randomized, nonblinded prospective, controlled trial w as undertaken to evaluate the effectiveness of pancreatic duct stents in pr eventing attacks of pancreatitis in IRP. Patients and Methods: During a 5-year period 34 patients met the diagnostic criteria for IRP. Patients were randomly assigned to one of two groups; 19 patients (14 women, 5 men, mean age 44) to the pancreatic stent group; and 15 patients (10 women, five men, mean age 47) to the control group. The st ent group received three stents over a period of 1 year and the control gro up had selective pancreatograms but no stent. Mean follow-up was 33 months (range 13-77) and 35 months (range 10-78) in the stent and control groups, respectively. Episodes of pancreatitis, frequency and intensity of pain req uiring emergency room visits, and hospitalizations were recorded. Results: Recurrence of pancreatitis occurred in eight out of 15 patients (5 3%) in the control group, but in only two our of 19 patients (11%) in the s tent group (P<0.02). Two patients in the control group who had recurrences of pancreatitis crossed over to stent therapy and had no further pancreatit is thereafter. Six patients each, 32% and 40% in the stent and control grou ps respectively, continued to have pancreatic type pain. In the study perio d 17 stents were occluded and 14 migrated out. Conclusion: The results of this study suggest that pancreatic duct stenting may prevent recurrent attacks of pancreatitis in IRP patients. Intermitten t pancreatic duct sphincter dysfunction or relative outlet obstruction may be the underlying cause for the recurrent attacks of pancreatitis.