Sphrincteronomy / stenting

[Guest guest]

Just to add my two cents worth into the stenting / sphincterotomy

discussion.

My first sphincterotomy of the sphincter of Oddi was painless, no

complications and successful as far as curing my biliary colic

attacks (this was done three weeks prior to diagnosing the

pancreas divisum). Recovery was quick and uneventful.

The ERCP / EUS - sphincterolomy of the minor papilla was very

painful, it induced post-ERCP acute pancreatitis and took three

weeks before I felt even a beginning of feeling human again.

The next ERCP, when he just replaced the stent and didn't do

any cutting or dilating did not cause AP and recovery from the

procedure was a week or so. The third ERCP, when the stent

was removed and a final dilation of the duct was done, I again

had post-ERCP pancreatitis and it took about three weeks to get

over the pain and nausea and stabilize.

It has been almost four months since the final ERCP and I would

say that I didn't recover from those until middle of Feb (about 8

weeks post final ERCP). I think the cumulative stress on the

body from the chronic obstruction and the therapy caused a long

healing process. Now that I have stabilized I can determine how

well the stenting worked. In the short term, the stents were a life

saver as I was completely blocked before the first one was done

and the pain levels were pretty severe as well as the weight loss

from not eating. However, in the long term, I have settled to a

pain level of 4 to 6 without pain meds with it shooting up after

meals or exertion. So the best I can say is that the procedure

was partly successful. It resolved the acute issues but not the

chronic ones.

What I have found to be the most successful therapy for my

chronic pain and nausea from symptomatic pancreas divisum (a

type of chronic pancreatitis) is daily, long-acting narcotics with

breakthrouhg meds PRN and zofran for the nausea. In my

particular circumstance, I have decided that stenting, for me,

should be reserved as a last resort , I-can't-live-like-this-any

-longer option. It was made very clear to me by the endoscopist

that did this stenting that everytime he went in I was risking future

severe problems with my pancreas for the benefit of temporary,

and incomplete pain resolution. But that is my particular case

only! I am not recommending that this is the position anyone

else should take!

Laurie