Endoscopic Therapy is Effective for Patients with Chronic Pancreatitis

Published on Jul 1, 2012in Clinical Gastroenterology and Hepatology8.549
· DOI :10.1016/J.CGH.2011.12.040
Bridger W. Clarke2
Estimated H-index: 2
(University of Pittsburgh),
Adam Slivka61
Estimated H-index: 61
(University of Pittsburgh)
+ 4 AuthorsDhiraj Yadav52
Estimated H-index: 52
(University of Pittsburgh)
Background & Aims Endoscopic therapy (ET) frequently is used to treat patients with painful chronic pancreatitis (CP), but little is known about outcomes of patients for whom ET was not successful who then underwent surgery, or outcomes after ET compared with only medical treatment. We evaluated use and long-term effectiveness of ET in a well-defined cohort of patients with CP. Methods We analyzed data from 146 patients with CP who participated in the North American Pancreatitis Study 2 at the University of Pittsburgh Medical Center from 2000 to 2006; 71 (49%) patients received ET at the University of Pittsburgh Medical Center. Success of ET and surgery were defined by cessation of narcotic therapy and resolution of episodes of acute pancreatitis. Disease progression was followed up from its onset until January 1, 2011 (mean, 8.2 ± 4.7 y). Results Patients who underwent ET had more symptoms (pain, recurrent pancreatitis) and had more complex pancreatic morphology (based on imaging) than patients who received medical therapy. ET had a high rate of technical success (60 of 71 cases; 85%); its rates of clinical success were 51% for 28 of 55 patients for whom follow-up data were available (mean time, 4.8 ± 3.0 y) and 50% for 12 of 24 patients who underwent surgery after receiving ET. Patients who responded to ET were significantly older, had a shorter duration of disease before ET, had less constant pain, and required fewer daily narcotics than patients who did not respond to ET. Among the 36 symptomatic patients who received medical therapy and were followed up for a mean period of 5.7 ± 4.1 years, 31% improved and 53% had no change in symptoms; of these, 21% underwent surgery. Conclusions ET is clinically successful for 50% of patients with symptomatic CP. When ET is not successful, surgery has successful outcomes in 50% of patients. Symptoms resolve in 31% of symptomatic patients who receive only medical therapy.
📖 Papers frequently viewed together
774 Citations
4 Authors (Petr Dítě, ..., Ivo Novotný)
532 Citations
169 Citations
#1David C. Whitcomb (University of Pittsburgh)H-Index: 89
#2Dhiraj Yadav (University of Pittsburgh)H-Index: 52
Last. M. Michael Barmada (University of Pittsburgh)H-Index: 52
view all 27 authors...
Background: Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are complex syndromes associated with numerous etiologies, clinical variables and complications. We deve
197 CitationsSource
#1Kenneth E. Fasanella (University of Pittsburgh)H-Index: 17
#2Brian M. Davis (University of Pittsburgh)H-Index: 59
Last. David C. Whitcomb (University of Pittsburgh)H-Index: 89
view all 7 authors...
Chronic, debilitating abdominal pain is arguably the most important component of chronic pancreatitis, leading to significant morbidity and disability. Attempting to treat this pain, which is too often unsuccessful, is a frustrating experience for physician and patient. Multiple studies to improve understanding of the pathophysiology that causes pain in some patients but not in others have been performed since the most recent reviews on this topic. In addition, new treatment modalities have been...
82 CitationsSource
#1Hartwig Riediger (University of Freiburg)H-Index: 14
#2Ulrich Adam (University of Freiburg)H-Index: 22
Last. Frank Makowiec (University of Freiburg)H-Index: 32
view all 7 authors...
Introduction Organ complications like biliary or duodenal stenosis as well as intractable pain are current indications for surgery in patients with chronic pancreatitis (CP). We present here our experience with pancreatic resection for CP and focus on the long-term outcome after surgery regarding pain, exocrine/endocrine pancreatic function, and the control of organ complications in 224 patients with a median postoperative follow-up period of 56 months.
145 CitationsSource
#1Jean-Marc Dumonceau (EUR: Erasmus University Rotterdam)H-Index: 75
#2Guido CostamagnaH-Index: 82
Last. Jacques DevièreH-Index: 102
view all 11 authors...
Background: In chronic pancreatitis, obstruction of the main pancreatic duct (MPD) may contribute to the pathogenesis of pain. Pilot studies suggest that extracorporeal shock wave lithotripsy (ESWL) alone relieves pain in calcified chronic pancreatitis. Aim: To compare ESWL alone with ESWL and endoscopic drainage of the MPD for treatment of pain in chronic pancreatitis. Subjects: Patients with uncomplicated painful chronic pancreatitis and calcifications obstructing the MPD. Methods: 55 patients...
236 CitationsSource
#1Djuna L. CahenH-Index: 26
#2Dirk J. GoumaH-Index: 101
Last. Marco J. BrunoH-Index: 67
view all 11 authors...
From the Departments of Gastroenterology and Hepatology (D.L.C., E.A.J.R., K.H., M.J.B.), Surgery (D.J.G., M.A.B., O.R.B.), Radiology (Y.N., J.S., J.S.L.), and Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), Academic Medical Center, Amsterdam. Address reprint requests to Dr. Cahen at the Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or
774 CitationsSource
#1R. P. Jalleh (Hammersmith Hospital)H-Index: 1
#2M. Aslam (Hammersmith Hospital)H-Index: 1
Last. R. C. N. Williamson (Hammersmith Hospital)H-Index: 18
view all 3 authors...
To assess the contribution of parenchymal hypertension to pain, pancreatic tissue pressures were measured intraoperatively in 17 patients with chronic pancreatitis and in four other patients undergoing pancreatic surgery (reference group). The technique involved direct fine needle cannulation of the pancreas using a flow infusion system, which measured parenchymal resistance to this infusion. Three to six recordings were obtained at each site. In chronic pancreatitis the pressure (mean ± s.e.m.)...
83 CitationsSource
#1Hiroshi Tadenuma (Chiba University)H-Index: 8
#2Takeshi Ishihara (Chiba University)H-Index: 20
Last. Hiromitsu Saisho (Chiba University)H-Index: 70
view all 8 authors...
Background & Aims: The aim of this study was to evaluate the short- and long-term results of extracorporeal shockwave lithotripsy (ESWL) and endoscopic therapy for pancreatic stones. Methods: A total of 117 patients with pancreatic stones underwent ESWL and endoscopic treatment in our institute. Seventy patients who were followed-up for over 3 years after treatment were evaluated retrospectively. Results: Immediate pain relief was achieved in 97% and complete removal of stones was achieved in 56...
84 CitationsSource
#1Douglas G. AdlerH-Index: 65
#2Todd H. BaronH-Index: 114
Last. Douglas O. FaigelH-Index: 61
view all 12 authors...
414 CitationsSource
#1Tim StrateH-Index: 26
#2Zohre TaherpourH-Index: 1
Last. Jakob R. IzbickiH-Index: 75
view all 9 authors...
Objective:To report on the long-term follow-up of a randomized clinical trial comparing pancreatic head resection according to Beger and limited pancreatic head excision combined with longitudinal pancreatico-jejunostomy according to Frey for surgical treatment of chronic pancreatitis.Summary Backgr
225 CitationsSource
#1N. Eleftheriadis (ULB: Université libre de Bruxelles)H-Index: 1
#2F. DinuH-Index: 2
Last. Jacques DevièreH-Index: 102
view all 8 authors...
BACKGROUND AND STUDY AIMS: Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-term outcomes after stent removal have not been fully evaluated. PATIENTS AND METHODS: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated for pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after s...
165 CitationsSource
Cited By50
#1Pauline M. StassenH-Index: 3
Last. Marco J. BrunoH-Index: 1
view all 5 authors...
#1Ellyn K. Dunbar (University of Pittsburgh)H-Index: 1
#2Jami L. Saloman (University of Pittsburgh)H-Index: 14
Last. David C. Whitcomb (University of Pittsburgh)H-Index: 89
view all 4 authors...
Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. ...
#1Kishore Vipperla (University of Pittsburgh)H-Index: 9
#2Alison Kanakis (University of Pittsburgh)
Last. Dhiraj Yadav (University of Pittsburgh)H-Index: 52
view all 12 authors...
Abstract Objectives Pain burn-out during the course of chronic pancreatitis (CP), proposed in the 1980s, remains controversial, and has clinical implications. We aimed to describe the natural course of pain in a well-characterized cohort. Methods We constructed the clinical course of 279 C P patients enrolled from 2000 to 2014 in the North American Pancreatitis Studies from UPMC by retrospectively reviewing their medical records (median observation period, 12.4 years). We assessed abdominal pain...
#1Giulia De MarchiH-Index: 6
#2Antonio AmodioH-Index: 13
Last. Luca FrulloniH-Index: 58
view all 3 authors...
#1Müjde Soytürk (Dokuz Eylül University)H-Index: 14
#3Göksel Bengi (Dokuz Eylül University)H-Index: 7
Last. Levent FilikH-Index: 10
view all 24 authors...
#1Søren Schou Olesen (AAU: Aalborg University)H-Index: 28
#2Asbjørn Mohr Drewes (AAU: Aalborg University)H-Index: 78
Last. Rupjyoti TalukdarH-Index: 21
view all 9 authors...
BACKGROUND: Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) has been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clin...
#1Y. Issa (UvA: University of Amsterdam)H-Index: 11
#2Marinus A. Kempeneers (UvA: University of Amsterdam)H-Index: 5
Last. Marja A. Boermeester (UvA: University of Amsterdam)H-Index: 5
view all 28 authors...
Importance For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. Objective To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. Design, Setting, and Participants The ESCAPE trial was an unblinded, ...
24 CitationsSource
#1Anna E. Phillips (University of Pittsburgh)H-Index: 5
#2Mahya Faghih (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 8
Last. Søren Schou Olesen (AAU: Aalborg University)H-Index: 28
view all 8 authors...
Abstract Background and aims Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST). Methods This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with pain...
5 CitationsSource
#1Gregory A. CoteH-Index: 42
#2Valerie Durkalski-Mauldin (MUSC: Medical University of South Carolina)H-Index: 6
Last. Dhiraj Yadav (University of Pittsburgh)H-Index: 52
view all 25 authors...
OBJECTIVES: In patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a sham-controlled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis. METHODS: T...
5 CitationsSource