7247 Impact of endoscopic treatment in painful chronic pancreatitis.

Abstract

Aim: To assess endoscopic treatment in hyperalgic chronic pancreatitis (CP). Patients and methods: Between 2/95 and 3/99, 21 patients (M: 17,W: 4), mean age 42 years (range: 22-69) with painful CP requiring dialy analgesic treatmentwith: central analgesic (such as dextropropoxyphen or codeine) or opioods,were admitted in our unit for endoscopic retrograde cholangio-pancreatography (ERCP). Endoscopic treatment consisted to pancreatic sphincterotomy +/- pancreatic stent insertion. Follow-up was performed including clinical (pain score, weight) and therapeutic evaluation (nature and dose of analgesic medication). Patients were classified into 3 groups according to follow-up: Group I (pain disappearance no analgesic treatment), Group II (pain and analgesic treatment decreased), Group III (no modification or increased pain and analgesic treatment). Results: All patients had ERCP with pancreatic sphincterotomy in each cases (morbidity 14.3%: acute pancreatitis (n=2), sepsis (n=1)). Sixteen patients underwent pancreatic stent (5 to 11.5 French; mean: 1.6 stent). Three patients with ductal pancreatic stones were totally healthed after pancreatic sphincterotomy and stones extraction. The median duration of treatment with pancreatic stent was 6.9 months (1-17). The median followup was 38 months (6-48). Distribution of patients after endoscopic treatment were: Group I (n=18), Group II (n=1), Group III (n=2).Weight variations were +5.3 Kgs, -3 Kgs and 4.5 kgs respectively for groups I, II and III. Patients in Group II and Group III had distal pancreatic duct stricture. Conclusion: After mean follow-up of 3 years, 86% of patients stopped analgesic treatment and a ponderal increase is observed in 3/4 of cases. Endoscopic treatment of painful PC with pancreatic stent insertion is a reliable, efficient and reproducible method.