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Am J Surg. 1995 Dec;170(6):543-6.

The challenge of therapy for pancreatitis-related common bile duct stricture.

Author information

1
Department of Surgery, Houston VAMC, Texas 77030, USA.

Abstract

BACKGROUND:

Opinions regarding the appropriate clinical management of pancreatitis-related common bile duct (CBD) stricture vary considerably.

PATIENTS AND METHODS:

Nineteen patients with chronic pancreatitis and proven stricture of their CBD were included in this study. Their mean duct diameter was 16 mm, bilirubin was 8.4 mg/dL, and alkaline phosphatase was 784 mIU/mL.

RESULTS:

Five patients initially treated with endoscopic biliary stent placement are doing well at a mean follow-up of 7 months with only 1 patient requiring a biliary-enteric bypass. Four patients underwent a pancreaticoduodenectomy and the other 10 patients underwent a biliary-enteric bypass. Mean bilirubin and alkaline phosphatase at 13 months after therapy were 0.9 mg/dL and 144 mIU/mL.

CONCLUSION:

An endoscopically placed biliary stent will relieve obstruction due to the stricture for several months and allow the inflammatory process to follow its natural course. In patients with long-standing permanent biliary stricture, pancreatitis limited to the head of the pancreas, duodenal obstruction, or suspected pancreatic head carcinoma, pancreaticoduodenectomy is the operation of choice. Biliary-enteric bypass in association with gastric or pancreatic bypasses should be reserved for patients with severe inflammatory changes preventing a safe pancreaticoduodenectomy.

PMID:
7491997
[Indexed for MEDLINE]

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