Incidence and Significance of Biliary Stricture in Chronic Pancreatitis Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Stones
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Background/Aims: This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi. Methods: A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records. Results: Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8). Conclusions: Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.
Abstract
Background/Aims: This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi. Methods: A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records. Results: Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8). Conclusions: Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.
참고문헌 (24)
- Kleeff J, "Chronic pancreatitis", Nat Rev Dis Primers, 3, pp.17060~ (2017)
- Drewes AM, "Guidelines for the understanding and management of pain in chronic pancreatitis", Pancreatology, 17, pp.720~731 (2017)
- Seven G, "Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis", Gastrointest Endosc, 75, pp.997~1004 (2012)
- Attwell AR, "ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis : a multicenter U. S. experience", Gastrointest Endosc, 82, pp.311~318 (2015)
- Li BR, "Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts", Gastrointest Endosc, 84, pp.69~78 (2016)
- Kalvaria I, "The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis", Ann Surg, 210, pp.608~613 (1989)
- Irani S, "Endoscopic treatment of benign biliary strictures using covered self-expandable metal stents(CSEMS)", Dig Dis Sci, 59, pp.152~160 (2014)
- Warshaw AL, "Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis", Gastroenterology, 70, pp.562~567 (1976)
- Familiari P, "ERCP for biliary strictures associated with chronic pancreatitis", Gastrointest Endosc Clin N Am, 23, pp.833~845 (2013)
- Delhaye M, "Endoscopic therapy for chronic pancreatitis", Scand J Surg, 94, pp.143~153 (2005)
- Gadacz TR, "Common bile duct complications of pancreatitis evaluation and treatment", Surgery, 93, pp.235~242 (1983)
- Singh SM, "The pathology of chronic pancreatitis", World J Surg, 14, pp.2~10 (1990)
- Warshaw AL, "Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts", Ann Surg, 192, pp.33~37 (1980)
- Cahen DL, "Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis : a case series", Endoscopy, 40, pp.697~700 (2008)
- Perri V, "Fully covered self-expandable metal stents in biliary strictures caused by chronic pancreatitis not responding to plastic stenting : a prospective study with 2 years of follow-up", Gastrointest Endosc, 75, pp.1271~1277 (2012)
- Kahaleh M, "Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: time to revisit our therapeutic options?", J Clin Gastroenterol, 47, pp.695~699 (2013)
- Devière J, "Successful management of benign biliary strictures with fully covered selfexpanding metal stents", Gastroenterology, 147, pp.385~395 (2014)
- Saxena P, "A US multicenter study of safety and efficacy of fully covered self-expandable metallic stents in benign extrahepatic biliary strictures", Dig Dis Sci, 60, pp.3442~3448 (2015)
- Coté GA, "Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution : a randomized clinical trial", JAMA, 315, pp.1250~1257 (2016)
- Chaput U, "Temporary placement of fully covered self-expandable metal stents for the treatment of benign biliary strictures", United European Gastroenterol J, 4, pp.403~412 (2016)
- Draganov P, "Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents", Gastrointest Endosc, 55, pp.680~686 (2002)
- Catalano MF, "Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis : comparison of single vs. multiple simultaneous stents", Gastrointest Endosc, 60, pp.945~952 (2004)
- Pozsár J, "Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents", J Clin Gastroenterol, 38, pp.118~123 (2004)
- Park JS, "Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures", Endoscopy, 48, pp.440~447 (2016)