Spectrum of use and effectiveness of endoscopic and surgical therapies for chronic pancreatitis in the United States.

Abstract

OBJECTIVE:

This study aims to describe the frequency of use and reported effectiveness of endoscopic and surgical therapies in patients with chronic pancreatitis treated at US referral centers.

METHODS:

Five hundred fifteen patients were enrolled prospectively in the North American Pancreatitis Study 2, where patients and treating physicians reported previous therapeutic interventions and their perceived effectiveness. We evaluated the frequency and effectiveness of endoscopic (biliary or pancreatic sphincterotomy, biliary or pancreatic stent placement) and surgical (pancreatic cyst removal, pancreatic drainage procedure, pancreatic resection, surgical sphincterotomy) therapies.

RESULTS:

Biliary and/or pancreatic sphincterotomy (42%) were the most common endoscopic procedure (biliary stent, 14%; pancreatic stent, 36%; P < 0.001). Endoscopic procedures were equally effective (biliary sphincterotomy, 40.0%; biliary stent, 40.8%; pancreatic stent, 47.0%; P = 0.34). On multivariable analysis, the presence of abdominal pain (odds ratio, 1.82; 95% confidence interval, 1.15-2.88) predicted endoscopy, whereas exocrine insufficiency (odds ratio, 0.63; 95% confidence interval, 0.42-0.94) deterred endoscopy. Surgical therapies were attempted equally (cyst removal, 7%; drainage procedure, 10%; resection procedure, 12%) except for surgical sphincteroplasty (4%; P < 0.001). Surgical sphincteroplasty was the least effective (46%; P < 0.001) versus cyst removal (76% drainage [71%] and resection [73%]).

CONCLUSIONS:

Although surgical therapies were performed less frequently than endoscopic therapies, they were more often reported to be effective.

• Authors: Lisa M Glass, David C Whitcomb, Dhiraj Yadav, Joseph Romagnuolo, Elizabeth Kennard, Adam A Slivka, Randall E Brand, Michelle A Anderson, Peter A Banks, Michele D Lewis, John Baillie, Stuart Sherman, Samer Alkaade, Stephen T Amann, James A Disario, Michael O'Connell, Andres Gelrud, Christopher E Forsmark, Timothy B Gardner, North American Pancreatic Study Group
• Journal: Pancreas (Pancreas) Vol. 43 Issue 4 Pg. 539-43 (May 2014) ISSN: 1536-4828 [Electronic] United States
• PMID: 24717802 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Chi-Square Distribution
• Cross-Sectional Studies
• Digestive System Surgical Procedures (adverse effects, trends)
• Endoscopy (adverse effects, trends)
• Female
• Health Care Surveys
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Pancreatitis, Chronic (complications, diagnosis, surgery)
• Postoperative Complications (etiology)
• Practice Patterns, Physicians' (trends)
• Prospective Studies
• Risk Factors
• Treatment Outcome
• United States