4690 Can response to stent placement help to select patients for operative management in chronic pancreatitis?

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Introduction: Patients with chronic pancreatitis (CP) and severe abdominal pain are often managed by operation or stent placement. However, the outcome of surgery is not always predictable. It has been suggested that patients who respond favorably to stent therapy may have satisfactory outcomes after surgery. Aim: In this prospective study, we sought to determine whether response to endoscopic pancreatic duct (PD) stent placement can predict outcome after surgery and thus help to select patients for operative management, and determine what other factors may predict clinical outcome. Methods: Patients referred with CP and pain underwent ERCP, sphincterotomy and PD stent placement. Outcome was considered good if pain relief was complete or allowed =50% decrease in pain medication and no hospitalizations. Patients with good response after 3 months of stent therapy who opted for surgery and those with poor response to stent therapy underwent operation. Baseline clinical data, outcome of surgery and complications were compared between the two groups. Results: A total of 56 patients (age 37-67, 36M, 20F) underwent ERCP. PD stent placement was successful in 39 patients. Four patients had mild pancreatitis. 32 patients had a good response to stent therapy. 20 of these patients had endoscopic therapy alone. The remaining 12 patients with good response opted for surgery (“good” group). All 7 patients with poor response to stenting underwent surgery (“poor” group). Response to surgery and follow-up are shown in the table below. There were no major surgical complications. Only 2 of 8 patients with alcoholic CP and narcotic use were able to stop narcotics completely after surgery. Conclusions: Response to short term endoscopic pancreatic duct therapy does not appear to predict outcome after surgery in patients with chronic pancreatitis and pain. Patients with multiple PD calculi who respond to stent therapy may do well after surgery, while those with alcoholic pancreatitis and narcotic use do not.