Dilation of refractory pancreatic duct strictures: the turn of the screw

Background: Endoscopic pancreatic ductal drainage may improve pain from chronic pancreatitis but stricture dilation may be technically difficult. Methods: Eight patients with refractory pancreatic strictures had dilation with a Soehendra stent retriever. Each had sphincterotomy, guidewire placement, stent retriever dilation to 7F to 10F, and stenting for 6 to 12 months. Results: All procedures were successful and 1 (13%) was complicated by mild pancreatitis. The mean follow-up was 21 months. Each patient had substantial pain relief with patent stents in place, but 7 (88%) relapsed with stent occlusion or removal. Four (50%) patients underwent surgery with excellent results. However, endoscopic therapy alone resulted in just modest benefits or pain recurrence in 3 (38%) and persistent relief in only 1 (13%). Conclusions: The Soehendra stent retriever is effective as a dilating device for pancreatic strictures resistant to conventional dilation. However, substantial symptom relief may persist only while patent stents are in place.