ENDOSCOPIC DRAINAGE IN BENIGN PANCREATIC DISEASE - IMMEDIATE AND MEDIUM-TERM OUTCOME

Objective: To elucidate further the role of endoscopy in the treatment of benign pancreatic disease. Design: Retrospective study. Setting: U niversity hospital, Sweden. Subjects: 136 of 319 patients who underwen t endoscopic retrograde cholangiopancreatography (ERCP) for known or s uspected pancreatic disease had abnormal findings at duodenoscopy or d uctography, or both. In 28 patients endoscopic treatment was considere d because of recurrent acute pancreatitis (n = 6), chronic pancreatiti s (n = 5), pancreatic pain syndrome (n = 5), pancreatic fistula with a scites (n = 1), and pseudocyst (n = 1), or appreciable biliary obstruc tion from chronic pancreatitis (n = 10). Interventions: Pancreatic duc t drainage was attempted in 18 patients and successful in 13 (72%). En doscopic sphincterotomy (EST) alone was done in 7/13 patients and an e ndoprosthesis (stent) was placed in 6/13. Bile duct drainage was attem pted and successful in 10 patients by EST together with dilatation wit h (n = 6) or without (n = 4) simultaneous placement of a stent. Main o utcome measures: Relief of pain and cholestasis. Results: Immediate (1 -30 days after initial treatment) and medium term (median 48 months af ter initial treatment) outcome after pancreatic duct-drainage was exce llent (no pain) or good (occasional mild pain) in 62% (8/13) and 67% ( 8/12) of the patients, respectively.-Complications of the endoscopic p rocedure were encountered in four patients (31%) and comprised infecti on with abscess formation (n = 1), repeated stent clogging (n = 1) or stent migration (n = 2). Surgery was subsequently required in three pa tients (23%) because of intraabdominal abscess (n = 1), recurrent pain (n = 1), or no pain relief (It = 1). At medium term follow-up (median 68 months) after biliary drainage 7/10 patients had liver function te sts within the reference ranges. Only two patients required subsequent biliodigestive shunts 7 and 13 months after EST, respectively. Conclu sion: Our findings favour endoscopic drainage as a safe and effective method for temporary and medium term relief of pain and biliary obstru ction in selected patients with benign pancreatic disease.