Management of cholestasis in patients with chronic pancreatitis: evaluation of a treatment protocol.

OBJECTIVE: Audit of the protocol that we have developed for treating patients with chronic pancreatitis and cholestasis.
DESIGN: Prospective open study. SETTINGS: University hospital, Finland. PATIENTS: 77 Patients admitted to hospital between 1992-93 with chronic pancreatitis, 18 of whom also had cholestasis (23%).
INTERVENTIONS: Eight patients were treated with observation only, one with percutaneous transhepatic biliary stenting, and nine patients were operated on. Hepaticojejunostomy was done in four patients, and pancreatic resection-either a pylorus-preserving Whipple operation or a duodenum-preserving Beger's operation-in five patients. MAIN OUTCOME MEASURES: Morbidity and mortality.
RESULTS: Seven of the eight patients treated conservatively recovered and their cholestasis had resolved within a month, but one died of acute fulminant cholangitis which was initially misdiagnosed as an acute exacerbation of chronic pancreatitis. The patient treated by percutaneous stenting died of secondary biliary cirrhosis and liver failure; she had been jaundiced for several months before referral to our department. Cholestasis resolved in all patients who were operated on. After hepaticojejunostomy one patient was reoperated on for bleeding and recovered. After pancreatic resection one patient developed a wound infection, central venous catheter infection, and pneumothorax, and recovered.
CONCLUSION: Cholestasis associated with chronic pancreatitis may be treated by conservative monitoring, biliary stenting, biliary bypass, or pancreatic resection depending on the clinical, biochemical, and radiological stage of the disease.