CLINICAL COURSE OF MEDICALLY MANAGED PATIENTS WITH LARGE AND SMALL DUCT CHRONIC PANCREATITIS.

Abstract

Pancreatic duct obstruction is the primary indication for endoscopic and/or surgical therapy in patients with chronic pancreatitis (CP). However, the clinical course of medically managed patients in relation to pancreatic duct obstruction is largely unknown. This was a retrospective cohort study of medically managed CP patients. We classified patients based on pancreatic duct obstruction from a stricture or stone using cross-sectional imaging (i.e., large vs small duct CP). We compared prevalence of diabetes and exocrine insufficiency (EPI) between subgroups at inclusion and investigated risk of new onset diabetes, EPI, and all-cause mortality over a follow-up period of 5 years. Changes in pancreatic morphology were studied in patients who underwent follow-up imaging. A total of 198 patients (mean age 58 ± 12 years, 70% male, 60% alcoholic aetiology, 38% large duct CP) were evaluated. At inclusion, patients with large vs small duct CP had a higher prevalence of both diabetes (43% vs 24%, P=0.004) and EPI (47% vs 28%, P=0.007). There was an increased risk of new onset EPI in patients with large duct CP (hazard ratio 1.72; 95% CI [1.05-2.80], P=0.031) and higher rates of pancreatic atrophy (P<0.001). No differences between groups were observed for new onset diabetes and all-cause mortality. Conversion from small to large duct CP or vice versa during follow-up was observed in 14% of patients. In a medically managed cohort of patients, large duct CP was associated with increased risk of EPI and pancreatic atrophy compared to small duct CP.