The inconsistent nature of symptomatic pancreatico-jejunostomy anastomotic strictures

Aram N. Demirjian, Tara S. Kent, Mark P. Callery, Charles M. Vollmer

Research output: Contribution to journalArticle

Abstract

Background: Pancreatico-jejunostomy strictures (PJS) after pancreatiocoduodenectomy (PD) are poorly understood. Methods: Patients treated for PJS were identified from all PDs (n = 357) performed for all indications in our practice (2002 to 2009). Technical aspects of the original operation, as well as the presentation, management and outcomes of the resultant stricture were assessed. Results: Seven patients developed a symptomatic PJS for an incidence of 2%. 'Soft' glands and small ducts (≤3 mm) were each present in 3/7 of the original anastomoses. Pancreatic fistula occurred in 6/7. The latency period to stricture presentation averaged 41 months. Diagnosis of PJS was confirmed by secretin magnetic resonance cholangio-pancreatography (MRCP). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was attempted - each unsuccessfully - in four patients. All patients required operative correction of their PJS by takedown/revision of the original pancreatico-jejunal anastomoses (PJA) (n = 4)± a modified Puestow (n = 2). One patient's PJS was completely inaccessible due to dense adhesions. Another patient's stricture recurred and was successfully revised with a stricturoplasty. At a mean follow-up of 25 months, all are alive, but only 4/7 are pain free. Conclusion: A symptomatic PJS appears to be independent of original pathological, glandular or technical features but pancreatic fistulae may contribute. Secretin MRCP is diagnostically useful, whereas ERCP has been proven to be therapeutically ineffective. Durable resolution of symptoms after surgical revision is unpredictable.

Original languageEnglish (US)
Pages (from-to)482-487
Number of pages6
JournalHPB
Volume12
Issue number7
DOIs
StatePublished - Sep 2010

Keywords

  • Chronic pancreatitis
  • Pancreatic duct occlusion
  • Pancreaticoduodenectomy
  • Whipple's procedure

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Fingerprint Dive into the research topics of 'The inconsistent nature of symptomatic pancreatico-jejunostomy anastomotic strictures'. Together they form a unique fingerprint.

  • Cite this

    Demirjian, A. N., Kent, T. S., Callery, M. P., & Vollmer, C. M. (2010). The inconsistent nature of symptomatic pancreatico-jejunostomy anastomotic strictures. HPB, 12(7), 482-487. https://doi.org/10.1111/j.1477-2574.2010.00214.x