Common Bile Duct Stenosis from Chronic Pancreatitis

Littenberg, Glenn; Afroudakis, A; Kaplowitz, Neil

doi:10.1097/00005792-197911000-00001

Cited by 67 publications

(32 citation statements)

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“…As more sophisticated imaging tools have been developed, our understanding of this clinical entity has evolved 1. Since the advent of non-operative cholangiography by PTC or ERCP, gastroenterologists have recognised a direct association between chronic pancreatitis and CBD stenosis 11…”

Section: Discussionmentioning

confidence: 99%

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Sylvester

Shuckett

Cutz

et al. 1998

Gut

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Background-Children with fibrosing pancreatitis are conventionally treated surgically to relieve common bile duct (CBD) obstruction caused by pancreatic compression. Residual pancreatic function has not been formally tested in these patients. Aims-To evaluate the usefulness of nonsurgical temporary drainage in children with fibrosing pancreatitis and to assess pancreatic function after resolution of their CBD obstruction. Patients-Four children (1.5-13 years; three girls).Methods and results-Abdominal sonography and computed tomography revealed diVuse enlargement of the pancreas, predominantly the head. The CBD was dilated due to compression by the head of the pancreas. Pancreatic biopsy specimens obtained in three patients showed notable acinar cell atrophy and extensive fibrosis. Cystic fibrosis was excluded. No other cause of pancreatitis was identified. Pancreatic tissue from one patient contained viral DNA sequences for parvovirus B19 detected by polymerase chain reaction; serum IgM to parvovirus was positive. Three patients had temporary drainage of the CBD and one patient underwent a choledochojejunostomy. Serial imaging studies revealed resolution of the CBD obstruction with reduction in pancreatic size. Exocrine pancreatic function deteriorated. Three patients developed pancreatic insuYciency within two to four months of presentation. The fourth patient has notably diminished pancreatic function, but remains pancreatic suYcient. None has diabetes mellitus. Conclusions-Temporary drainage of the CBD obstruction is recommended in fibrosing pancreatitis in children along with close monitoring of the clinical course, before considering surgery. (Gut 1998;43:715-720)

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Section: Discussionmentioning

confidence: 99%

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Sylvester

Shuckett

Cutz

et al. 1998

Gut

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“…After a mean of 38 months follow-up, 84% of patients remained pain-free [198]. Asymptomatic common bile duct dilation in patients with normal liver function tests may be detected by imaging techniques (MRCP, CT) in patients with chronic pancreatitis [201][202][203][204]. There are no predictive factors available to stratify the risk of developing cholestasis and secondary biliary cirrhosis, and to determine which patients could benefit from an endoscopic therapy.…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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“…Twenty-nine percent of the patients in our study, all of whom were referred for symptomatic chronic pancreati tis, suffered from cholcstatis which was more common in patients without pseudocysts. This has been the experi ence of others [22,23]. It is likely that the more sclerosing type of inflammation is a contributory factor.…”

Section: Discussionmentioning

confidence: 90%

Complications of Chronic Pancreatitis

Seiler¹,

Boss²,

Czerniak³

et al. 1997

Dig Surg

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In order to define the risk factors resulting in morbidity and mortality, 154 patients referred to a surgical clinic because of suspected complications of chronic pancreatitis were studied. Pain was significantly more common (p = 0.006) in the presence of pseudocysts. The most important prognostic risk factor in chronic pancreatitis was found to be pseudocyst formation showing a significantly higher incidence of vascular complications (p = 0.0006), gastrointestinal symptoms (p = 0.003) and fistula formation (p = 0.04) when compared to patients without pseudocyst who showed a significantly higher incidence of cholestasis only (p = 0.002). The mortality rate in the pseudocyst group (7.1 %) was 4 times higher than that in the nonpseudocyst group (1.8%). The triad of a history of alcohol consumption, male gender and pseudocyst formation, occurring in 59 patients (38%), was associated with a 8.5% mortality rate.

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Common Bile Duct Stenosis from Chronic Pancreatitis

Cited by 67 publications

References 0 publications

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Italian consensus guidelines for chronic pancreatitis

Complications of Chronic Pancreatitis

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