Pancreatic duct strictures

Abstract

The treatment of pancreatic duct strictures is based on an accurate assessment of the etiology of the disease, and then the degree of symptomatology. Our outline for therapy is as follows: Exclude a diagnosis of malignancy by using radiologic, endoscopic, histologic, and molecular biologic modalities. Once a benign stricture has been demonstrated, we favor a trial of endoscopic dilation and stent placement For the unresectable pancreatic neoplasm, in which an obstructive etiology for pain is suspected, a trial of endoscopic dilation and stent placement also should be considered. In benign pancreatic duct strictures complicated by biliary obstruction, and where the most durable treatment modality is sought, surgical intervention merits earlier consideration. Pancreatic duct stent placement should seldom be considered definitive therapy, and the risk of stent-induced duct injury must be weighed against potential therapeutic benefit.

Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management

“…The diagnosis of malignancy should be excluded by utilizing radiologic, endoscopic, histologic and/or molecular biologic modalities [1]. Differentiating benign (inflammatory) and malignant pancreatic duct strictures is both complex and challenging despite the methods that are readily available to acquire samples for diagnostic purposes during endoscopic retrograde cholangiopancreatography (ERCP).…”

Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients: a systematic review and meta-analysis

“…Before the procedure, the ductal anatomy needs to be delineated by cross-sectional imaging, or EUS, to localize the stricture accurately and to rule out ductal anomalies, such as pancreas divisum, seen in 7% of patients and which would warrant ductal access via the minor papilla [ 54–56 ]. PD-stricture dilation is performed when a larger-diameter PD stent needs to be deployed [ 57 ]. Ideally, a soft 10 Fr stent with side-holes, or multiple side-by-side smaller-caliber stents, should be placed into the PD.…”

Probe‐based confocal laser endomicroscopy for the diagnosis of pancreatic ductal structures

“…Pancreatic ductal adenocarcinoma is associated with one of the worst cancer-related mortality rates in developed countries, [18] and its diagnostic exclusion from differential diagnosis requires rigorous approaches using radiological, endoscopic, pathological, and/or molecular biology modalities. [19] Surgery should be performed in cases with resectable PDAC. [20][21][22] Therefore, rapid and accurate diagnosis of PDAC is critical.…”