Long-term outcome after pancreatic stenting in severe chronic pancreatitis

Background and Study Aims: Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-term outcomes after stent removal have not been fully evaluated. Patients and Methods: A total of 100 patients (75 men, 25 women: median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated for pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged "on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectively assessed as potential predictors of re-stenting. Results: The etiology of the chronic pancreatitis was alcoholic (77%), idiopathic (18%), or hereditary (5%). Patients were followed up for a median period of 69 months (range 14-163 months) after study entry, including a median period of 27 months (range 12-126 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2-134 months). After attempted definitive stent removal, 30 patients (30%) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1-12 months), while in 70 patients (70%) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had required re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002). Conclusions: The majority (70%) of patients with severe chronic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However, a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.