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.  

[MarceloScotti]

I had a gall bladder removed via laparoscopic surgey two years ago. When I left the OR, I noticed I had a JP or GP in the right side of my abdomen, I ask the doctor What is this?? and he told me that it was to drain the fluids from surgery. Since I am not a doctor it made sense to me. After one day in the hospital I notice this JP or GP filled with some brown yellow fluid, so I ask the nurse what is this fluid I have, she didn't know what to say to me so she went to call the Doctor, of course the doctor went on vacation July 4th. He never showed to my room never went to see me after the surgey. Anyway, his assistant went and he told me that I was leaking bile, so I ask how come? he didn't know what to say, then I ask again How come I am leaking bile? didn't the doctor checked after the surgery for leaks or to make sure everything is ok??, well he got mad at me and told me : I was not there during surgey and then he just left and never came back. After 4 days in the hospital finally the DOCTOR who did the surgey came to se me and he told me that I was leaking bile and he doesn't know why and from where. After 10 days and numerous tests, exams, MRI, ultrasounds and whatever they could do they found the leak, they say that one of the clips moved, MOVED??? I said, how can it move?? by itself? or you did it wrong but you were in a hurry to go on your long weekend holiday for the 4th of July, well the doctor got offended and left the room. Soon enough another doctor shows up and tell me I have to have a ERCP to put a stent to stop the leak. Back to the OR. I have the ERCP done, they put the sten inside the bile duct to my intestin, so they said. Well, guess what? It didn't stop the leak I was leaking 120 cc everyday of bile. So after 16 days in the hospital with a lot of pain the Doctor decide that he has to go inside again to look for the leak. He went inside and all he did was as he told me: One of the clips moved so I put a stich on the duct to close the leak. Now my question, the other doctor who did the ERCP told me I have to get the stent out in 6 weeks. I never did I feel very good, I even do a lot of exercise and I don't feel anything. I wonder if they really put a stent in because since they never stop the leak maybe ...... who knows maybe he just lied to me about putting a stent in me... It was supposed to be an outpatient and I end up staying  21 days, What a screw up

[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.

[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, 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.