INTRODUCTION: Little is known about the effects of endoscopic pancreatic duct (PD) decompression in patients with 'obstructive type' pain from pancreatic carcinoma. METHODS: Twenty patients with unresectable carcinoma of the pancreas, PD obstruction and postprandial epigastric pain were enrolled. The pain intensity, opioid dose and quality-of-life index were documented pre-treatment and at 4-weekly intervals. PD stenting was attempted in all patients. PD stent change was performed if biliary stents had to be changed or intense pain relapsed. RESULTS: Endoscopic PD drainage was successful in 19/20 patients by placement of a 7 F (n = 9) or 10 F (n = 10) plastic stent. Median follow-up was 16 weeks. Two patients were alive at the end of follow-up. Eleven patients received gemcitabine chemotherapy. The pre-interventional pain score was 6.7 +/- 0.9 points and decreased to 3.1 +/-1.4 points at 4 weeks (P < 0.001). It remained lowered significantly at 8/12 weeks and at the final visit (4.2 +/- 1.5 points, n = 13). The mean pre-stenting fentanyl dose was 85.5 +/- 34.7 microg/h, and it was decreased to 57.9 +/- 39.1 microg/h after 4 weeks (P < 0.01), 60.5 +/- 38.9 microg/h after 8 weeks and 64.1+/-39.8 microg/h (P < 0.01 versus pre-treatment) after 12 weeks but increased to 82.7 +/- 41.3 microg/h (NS) at the final visit. The quality-of-life index improved 4 weeks after stenting (from 4.8+/-1 to 6.2+/-1.5 points, P < 0.01) but was lowered to 5.5 +/- 2.3 points at 12 weeks (NS). The response was independent of stent diameter and chemotherapy. CONCLUSION: PD stenting achieved significant pain relief and short-term improvement of the quality of life in the majority of patients with PD obstruction due to pancreatic carcinoma.
INTRODUCTION: Little is known about the effects of endoscopic pancreatic duct (PD) decompression in patients with 'obstructive type' pain from pancreatic carcinoma. METHODS: Twenty patients with unresectable carcinoma of the pancreas, PD obstruction and postprandial epigastric pain were enrolled. The pain intensity, opioid dose and quality-of-life index were documented pre-treatment and at 4-weekly intervals. PD stenting was attempted in all patients. PD stent change was performed if biliary stents had to be changed or intense pain relapsed. RESULTS: Endoscopic PD drainage was successful in 19/20 patients by placement of a 7 F (n = 9) or 10 F (n = 10) plastic stent. Median follow-up was 16 weeks. Two patients were alive at the end of follow-up. Eleven patients received gemcitabine chemotherapy. The pre-interventional pain score was 6.7 +/- 0.9 points and decreased to 3.1 +/-1.4 points at 4 weeks (P < 0.001). It remained lowered significantly at 8/12 weeks and at the final visit (4.2 +/- 1.5 points, n = 13). The mean pre-stenting fentanyl dose was 85.5 +/- 34.7 microg/h, and it was decreased to 57.9 +/- 39.1 microg/h after 4 weeks (P < 0.01), 60.5 +/- 38.9 microg/h after 8 weeks and 64.1+/-39.8 microg/h (P < 0.01 versus pre-treatment) after 12 weeks but increased to 82.7 +/- 41.3 microg/h (NS) at the final visit. The quality-of-life index improved 4 weeks after stenting (from 4.8+/-1 to 6.2+/-1.5 points, P < 0.01) but was lowered to 5.5 +/- 2.3 points at 12 weeks (NS). The response was independent of stent diameter and chemotherapy. CONCLUSION:PD stenting achieved significant pain relief and short-term improvement of the quality of life in the majority of patients with PD obstruction due to pancreatic carcinoma.
Authors: G Lazaraki; J Kountouras; S Metallidis; S Dokas; T Bakaloudis; D Chatzopoulos; E Gavalas; C Zavos Journal: Surg Endosc Date: 2007-02-16 Impact factor: 4.584
Authors: Andrew L Coveler; Jonathan Mizrahi; Bory Eastman; Smith Jim Apisarnthanarax; Shalini Dalal; Terry McNearney; Shubham Pant Journal: Oncologist Date: 2021-05-12