Role of endoscopic elimination of protein plugs in the treatment of chronic pancreatitis.

The purpose of this report is to evaluate the role of endoscopic elimination of protein plugs in the treatment of chronic pancreatitis (CP) and suspected CP. Endoscopic aspiration of pure pancreatic juice (PPJ) was performed on 69 patients with CP or suspected CP. PPJ was collected from within the main pancreatic duct by endoscopic retrograde catheterization of the papilla after a rapid intravenous injection of secretin and CCK-PZ. Following results were obtained. (1) Various numbers of protein plugs were obtained along with PPJ in 26 of the 69 patients. (2) Endoscopic elimination of protein plugs provided 17 of the 26 patients with dramatic relief from abdominal pain and back pain, indicting that the procedure was often useful, at least, for relieving pain in patients with protein plugs in the pancreatic duct system. (3) Follow-up studies suggested that the procedure could be an effective therapeutic tool in selected cases of CP or suspected CP in which no prominent stenotic lesions were noted in the major pancreatic duct system and abstinence from alcohol beverage was strictly observed. (4) In 43 patients with no protein plugs in the pancreatic juice, in contrast, transient or partial relief from abdominal pain was provided in only one patient, respectively.