Endoscopic pancreatic-stent placement and sphincterotomy for relief of pain in tropical pancreatitis: results of a 1-year follow-up

BACKGROUND: Tropical chronic pancreatitis frequently presents with intractable abdominal pain. Surgical treatment has its own morbidity and mortality, and long-term results may not be satisfactory. OBJECTIVE: To analyze the results of endoscopic pancreatic-stent placement and sphincterotomy for the pain of tropical pancreatitis. DESIGN: Retrospective review. SETTING: Tertiary-referral hospital. PATIENTS: Twenty-four patients with tropical pancreatitis with severe, persistent pain not responding to standard medical therapy over a period of 30 months beginning January 1998. INTERVENTIONS: Stent placement of the pancreatic duct, along with sphincterotomy. MAIN OUTCOME MEASUREMENTS: At least 80% global improvement in pain as reported by the patient during follow-up after the procedure. RESULTS: In the 19 evaluable patients, the intended procedure, pancreatic stent placement along with sphincterotomy, was successful in 14 (73.7%); 3 others had sphincterotomy alone. Over a follow-up period of 6 to 38 months, 12 of the 14 patients (85.7%) who underwent stent placement plus sphincterotomy and 2 of the 3 patients who had sphincterotomy alone responded. Twelve of these were completely free of pain, and the remaining 2 patients had mild infrequent pain that occurred once in 2 to 4 months, lasting a few hours at a time and never needing hospitalization. The only major complication was the development of pancreatic sepsis, which required stent removal in 1 patient. Eight patients were stent free at the end of 6 months, and, over a further follow-up of 6 to 20 months, the pattern of pain relief persisted in them. LIMITATIONS: The retrospective nature of the study, the limited numbers studied, and the lack of assessment of pain on a standard visual analog scale. CONCLUSIONS: Stent placement of the pancreatic duct with pancreatic sphincterotomy constitutes an important nonsurgical therapeutic option for the intractable pain of tropical pancreatitis.