Pancreatitis

The pancreas is located deeply in the abdomen just behind and bit below the stomach. It produces Enzymes, or digestive juices, that are secreted via a pancreatic duct into the small intestine – duodenum. There, it continues breaking down (digestion) of the food that has left the stomach. The pancreas also has an endocrine function - it releases insulin directly into the bloodstream, with that participating in blood sugar regulation.

About Pancreatitis

Numerous intra or extra-pancreatic pathological conditions and diseases (both – benign and malignant) may cause partial or complete obstruction of the pancreatic fluid flow through the main pancreatic duct. The most common benign conditions causing pancreatic duct obstruction are bile duct and pancreatic duct stones and benign strictures of pancreatic duct. The broad spectrum of malignant conditions may also lead to extrinsic compression and obstruction of the pancreatic duct.

The pancreatic fluid flow impairment frequently induces the acute pancreatitis - a severe disorder, which may lead to significant morbidity and even mortality. Even when treated appropriately, post-acute-pancreatitis patient often suffers from chronic pancreatitis with lifelong recurrences manifested by pain, digestion problems and need of permanent dietary restrictions. Long-standing pancreatic duct obstruction and dilation (widening) leads to pancreatic tissue atrophy, manifested by endocrine function impairment, revealed by either onset or advancement of existing diabetes.

Treating Pancreatitis

Department of Interventional Radiology at New Hospitals offers unique and effective treatment options for pancreatic duct dilation, constriction, and pancreatic duct stones. The treatment, elaborated by prof. Malkhaz Mizandari and his team is being successfully applied to the patients since 2010. Many scientific papers on this topic have been published in highly ranked scientific journals and presented on international scientific symposia and congresses on Interventional Radiology. This approach might be extremely helpful when chronic treatment is ineffective and alternate techniques (e.g. conventional or Ultrasound-assisted endoscopic drainage or major surgery) are impossible to perform or have failed.

The idea is simple – the first step is the pancreatic duct decompression by percutaneous drainage. This is a low-invasive imaging-guided procedure, which does not require general anesthesia. By the end of it, a small size drainage catheter is positioned in dilated pancreatic duct maintaining its constant decompression via pancreatic fluid flow into the receiving bag. The immediate effect of pancreatic duct drainage is the alleviation of pancreatitis, revealed by the improvement of clinical symptoms (mainly pain) and the necessity of dietary restrictions. The later effect is the gradual improvement of diabetes – decompression allows complete or partial reversal of the pancreatic atrophy process.

The spectrum of so-called “Second-Line” procedures is performed in few days once the pancreatic duct has been drained. These procedures do not need any surgical incision. They can reestablish normal pancreatic fluid flow into the duodenum, finally enabling to withdraw all drains. “Second-Line” interventions include:

• Benign stricture recanalization by balloon dilatation with or without subsequent stent implantation.
• Balloon Assisted Percutaneous Descending Litholapaxy (BAPDL procedure) – the stone evacuation into the duodenum from pancreatic duct
• Malignant stricture recanalization by endoluminal RFA (local tumor radiofrequency ablation) and stent implantation