When the stent is withdrawn 7 days after insertion, the pancreatic stricture is dilated (Fig. 5c). Short-term AZD2281 supplier metallic stenting is useful method for dilating

strictures of the pancreatic duct and shows promise for preventing pancreatic stone recurrence after lithotripsy in patients with pancreatic stricture. We performed the procedure in five patients with advanced chronic pancreatitis, all of whom experiencing successful dilation without recurrence of pancreatic stones during a mean observation period of 45.6 months. We therefore believe that this short-term treatment will prove effective in preventing recurrence of pancreatolithiasis. Recently, Moon et al.[29] reported good results using a self-expandable metallic stent for pancreatic stricture. When those authors inserted a fully covered metallic stent or performed temporary

stenting for 3 months, pancreatic strictures resolved in patients with advanced chronic pancreatitis. Such methods are promising in prevention of stone recurrence after lithotripsy in patients with pancreatic stricture. In our experience, pancreatic ductal carcinoma (PDAC) developed in 6 of 112 patients with pancreatolithiasis (5.4%). Only two NVP-BGJ398 molecular weight of the six patients had resectable stage IB or IIA tumors, illustrating the difficulty of diagnosis at an early stage. Pancreatolithiasis is a high-risk factor for PDAC and has other potential complications, such as pancreatic atrophy and irreversible loss of exocrine and endocrine function. Further, stone recurrence after treatment of pancreatolithiasis is very frequent. Considering the importance of early treatment, diagnostic MCE criteria for chronic pancreatitis were revised in 2009[30] by a study group of the Japanese Ministry of Health, Labour and Welfare for intractable pancreatic diseases, together with the Japan Pancreas Society. The result was a proposed concept of “early chronic pancreatitis.” According to the new criteria, early chronic pancreatitis is diagnosed when more than two of four items suggesting chronic pancreatitis are present together with characteristic early findings by imaging (mainly endoscopic ultrasonography). The four items are repeated upper abdominal pain, abnormal

pancreatic enzyme levels in serum or urine, abnormal pancreatic exocrine function, and continuous heavy drinking of alcohol equivalent to over 80 g/day of pure ethanol. The seven early endoscopic ultrasound (EUS) findings of early chronic pancreatitis (Figs 6, 7) include five parenchymal and two ductal abnomalities: (i) lobularity with honeycombing; (ii) lobularity without honeycombing; (iii) hyperechoic foci without shadowing; (iv) stranding; (v) cysts; (vi) dilated side branches; and (vii) hyperechoic MPD margin. More than two features of these seven EUS findings are required, including at least one of (i) to (iv). The aim of adopting the category of early chronic pancreatitis is prevention of development intractable disease by early treatment. Hirota et al.