Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
World J Gastroenterol. 2010 Mar 28;16(12):1541-4. doi: 10.3748/wjg.v16.i12.1541.
Endoscopic therapy of pancreatic duct (PD) strictures using balloon dilation and pancreatic duct stent (PS) placement has been reported to improve the severity of abdominal pain in selected patients with chronic pancreatitis (CP). However, some strictures are refractory and require frequent PS exchange to control symptoms. We describe two cases of successful endoscopic PD incision for difficult PD stricture using a wire-guided snare. The snare is partially opened within the strictured pancreatic duct while applying current, thus incising the duct. Although both cases were successful without complications we do not advocate that this method be used routinely because of the potential for severe complications, e.g. bleeding, ductal perforation or pancreatic parenchymal damage. In order to prevent these complications, we developed a wire-guided technique under fluoroscopic control. We think this procedure may be useful in patients with short, straight PD strictures. Although further study is required, this approach may have potential for selected patients with refractory PD strictures due to CP.
采用球囊扩张和胰管支架（PS）置入的内镜治疗胰腺管（PD）狭窄已被报道可改善某些慢性胰腺炎（CP）患者腹痛的严重程度。然而，有些狭窄是难治性的，需要频繁更换 PS 以控制症状。我们描述了两例使用导丝引导的圈套成功治疗难治性 PD 狭窄的病例。圈套在狭窄的胰管内部分打开，同时施加电流，从而切开胰管。尽管两例均成功且无并发症，但我们不主张常规使用这种方法，因为存在严重并发症的风险，例如出血、胰管穿孔或胰实质损伤。为了预防这些并发症，我们在荧光镜控制下开发了一种导丝引导技术。我们认为这种方法可能对短而直的 PD 狭窄患者有用。尽管需要进一步研究，但由于 CP 导致的难治性 PD 狭窄患者，这种方法可能具有一定的潜力。
