Stenting of Bile & Pancreatic Ducts

[neuromanager]

I recently had both my bile duct and pancreatic duct stented via ERCP and sphincterotomies performed on both.  This is the first sphincterotomy of the pancreatic duct and the 3rd of the bile duct.  ERCP showed some morphologic changes of the pancreatic duct of unclear clinical significance.   The stents were left in for two days and then taken out.  I have now had a total of 5 ERCP's in the last 18 years, two of them being this last week.  (I have a pancreatitis attack after each and developed chronic pancreatitis after my second ERCP in 1992.)  I was somewhat surprised when my gastroenterologist at Barnes-Jewish West in St. Louis told me the stents would only be left in for two days.  I thought they could be left in for a few months but he said they are too prone to infection and other problems so he leaves them in no longer than two days.  Of course, restenosis can occur and he said I will have to go through this everytime it happens.  Seems a little much to me. Just curious to know how up you guys are on stenting and if it is common to only leave these stents in for a couple of days.  Thanks for you input.  

[CalGal]

Neuromanager, I'm curious to know whether each time you have had this done you have had the manometry portion of the test done? And if so, has the pressure always read hight, over 40?

My understanding is that the stents are left in for a longer period of time than two days. In some cases, the stents can be left in for a period of weeks. Especially if a person is being treated for SOD.

[neuromanager]

Manometry was performed at each ERCP and readings were over 40.

I feel 90% better than I did before the procedures last week but am concerned about restenosis.  At one point I had restenosed 7 months after a surgical sphincterotomy and had to have another ERCP w/extension of the surgical sphincterotomy.  

My question is just how many sphincterotomities can they do?  Another concern is the fact that I have a major pancreatitis attack after every ERCP and am concerned about damage to the pancreas in the future.  The last endoscopic ultrasound I had of the pancreas was in 1995 and it was fine but that was a long time ago.  Pancreas looked OK on MRCP and nothing was said to me about the pancreas last week.  Just want to be prepared for what might be down the road.

Thanks for any input.

[CalGal]

Neuromanager, each sphincterotomy forms scar tissue, so I'm not sure anyone can give you a 'number' that can be done. It will depend upon a variety of different parameters and some of those will differ with each person. But at some point you may have to consider other surgical options which might include a choledochoduodenostomy (duodenum stitched to theh duct to create a new opening) or choledochojejunostomy (a bit more complex, requiring disconnecting and reconnecting the jejunum into a Y-shape). You may want to sit down to discuss the issue with your GI doc since he/she knows your system and your history and will have factual information on what can or can't be done.