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[Evaluation of pancreatic ductal decompression procedure for patients with advanced chronic pancreatitis, mainly from the viewpoint of pancreatic ductal changes].

Several pancreatic ductal decompression procedures have been applied for chronic pancreatitis. Unresolved problems, however, remain, i.e., to select the appropriate procedure among several different decompression procedures, to investigate the changes of pancreatic endocrine and exocrine functions resulting from such procedures, etc. In this paper we evaluated these problems, mainly by comparing conditions of the pancreatic duct as seen with pre- and post-operative endoscopic retrograde pancreatography (ERP). We classified the pancreatic duct of patients with chronic pancreatitis into seven types. This classification was devised so that the selection of the suitable operative procedure could be made. The severity of the abnormal ductal change was also evaluated. Eighteen patients were studied with reference to the post-operative change in the pancreatic duct and the patency of the pancreaticoenteral anastomosis in each procedure. Postoperative ERP showed good patency in the patients with lateral pancreaticojejunostomy and modified bilateral pancreaticojejunostomy, both having long anastomotic stoma. Among the findings of postoperative pancreatic ductal changes, the dilatation of the main duct was reduced in most of the patients, while the stenosis of the main duct remained unchanged in nearly all the patients. The duct in the tail area showed the best results, which suggested the importance of preservation of the pancreatic tail.