• A 15 year old female presented with pain in abdomen radiating to back since 1 year
  • lateral pancreatico-jejunostomy two years back for chronic calculus pancreatitis
  • EUS- MPD appeared dilated (6.5mm) in head region with multiple stone
  • ERP-
  • Selective cannulation through major papilla and Sphincterotomy was performed.
  • Guide wire was passed deep in to the jejunum across the anastomotic site
  • Pancreatogram- pre papillary stricture with stricture at anastomotic site with multiple stones in head and tail region. Stricture dilatation was performed with 8mm balloon
  • A 7 Fr double pig tail stent was placed across the anastomotic site.
  • Patient underwent few sessions of ESWL for residual stones
  • Follow up ERP after 3 months-
  • Previously placed 7 Fr stent was removed. Selective cannulation of MPD
  • Pancreatogram- dilated MPD, resolved pre papillary and anastomotic site stricture
  • Complete ductal clearance was achieved with stone extraction balloon catheter
  • Patient was asymptomatic on further clinical follow ups

EXPERT COMMENTS-

  • Endotherapy in conjunction with ESWL has been shown to increase stone clearance rates and to improve long-term outcomes in patients with stone and stricture disease
  • Surgery can be avoided in more than 80% of patients who underwent pancreatic endotherapy in conjunction with ESWL ,with decrease in narcotic use and reduction in need for hospitalizations
  • Surgical drainage is associated with a mortality rate of up to 5%, and long-term prognosis is not as good because pain may recur in up to 50% of patients within 5 years after surgery

TAKE HOME MESSAGE-

  • Advances in understanding the pathogenesis of CP combined with progress in technology have led to an emerging role of endoscopy in the management of CP
  • Experts believe that endoscopic management has an important role in patients as a primary therapeutic measure
Dilated MPD with multiple stones

Dilated MPD with multiple stones

Major papilla sphincterotomy

Major papilla sphincterotomy

 

 

 

 

 

 

 

 

 

Stricture dilatation with 8 mm balloon

Stricture dilatation with 8 mm balloon

A 7 Fr double pig tail stent was placed

A 7 Fr double pig tail stent was placed

 

 

 

 

 

 

 

 

 

Pancreatogram showing pre papillary stricture with stricture at anastomotic site with multiple stones

Pancreatogram showing pre papillary stricture with stricture at anastomotic site with multiple stones

A 7 Fr double pig tail stent in situ

A 7 Fr double pig tail stent in situ

 

 

 

 

 

 

 

 

 

 

Complete ductal clearance achieved

Complete ductal clearance achieved

Resolved pre papillary and anastomotic site stricture

Resolved pre papillary and anastomotic site stricture

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