Endoscopic Treatment for Pain Relief in Chronic Pancreatitis: A Cross-Sectional Analysis by Korean Multicenter Study Group on Chronic Pancreatitis

Abstract

Background: Endoscopic treatment has become one of the treatment options for chronic pancreatitis. However, there are some groups of patients who are refractory to this treatment. It is not clear which subgroup could be benefited by pancreatic endotherapy. The purpose of this study is to analyze the result of endoscopic treatment of chronic pancreatitis in Korea and to identify a subgroup in which pancreatic endotherapy is helpful for the relief of pain. Method: From 14 different academic centers, 432 patients with chronic pancreatitis were screened and 137 patients who received endoscopic treatment were enrolled in this study. Using structured questionnaires, following data were collected: demographic data, response to pain medication, type of endoscopic treatment, and response to endoscopic treatment. Results: The patients were categorized into 3 different groups depending on their ductal pathology: ductal stones (23.4%), dominant strictures (46.8%), stones with strictures (29.8%). The types of endoscopic treatment were endoscopic pancreatic sphincterotomy(EPST) alone (10.5%), EPST+stent placement(68.6%), or EPST+stent placement+extracorporeal shock wave lithotripsy (ESWL)(20.9%). There was no significant difference in pain response rate according to the type of treatment. The diameter of stents, duration of pancreatic stenting and etiology of pancreatitis did not affect the response rate. However, the response rate was significantly lower in the patients with predominant ductal strictures (70.5%) than those in patients with stones (81.8%) or stones and stricures (85.7%) (p<0.05). Conclusions: Endoscopic treatment can be offered as a reasonable alternative to surgery for pain relief in chronic pancreatitis. However, careful patient selection seems to be important to improve the response rate, especially in patients with predominant strictures. Background: Endoscopic treatment has become one of the treatment options for chronic pancreatitis. However, there are some groups of patients who are refractory to this treatment. It is not clear which subgroup could be benefited by pancreatic endotherapy. The purpose of this study is to analyze the result of endoscopic treatment of chronic pancreatitis in Korea and to identify a subgroup in which pancreatic endotherapy is helpful for the relief of pain. Method: From 14 different academic centers, 432 patients with chronic pancreatitis were screened and 137 patients who received endoscopic treatment were enrolled in this study. Using structured questionnaires, following data were collected: demographic data, response to pain medication, type of endoscopic treatment, and response to endoscopic treatment. Results: The patients were categorized into 3 different groups depending on their ductal pathology: ductal stones (23.4%), dominant strictures (46.8%), stones with strictures (29.8%). The types of endoscopic treatment were endoscopic pancreatic sphincterotomy(EPST) alone (10.5%), EPST+stent placement(68.6%), or EPST+stent placement+extracorporeal shock wave lithotripsy (ESWL)(20.9%). There was no significant difference in pain response rate according to the type of treatment. The diameter of stents, duration of pancreatic stenting and etiology of pancreatitis did not affect the response rate. However, the response rate was significantly lower in the patients with predominant ductal strictures (70.5%) than those in patients with stones (81.8%) or stones and stricures (85.7%) (p<0.05). Conclusions: Endoscopic treatment can be offered as a reasonable alternative to surgery for pain relief in chronic pancreatitis. However, careful patient selection seems to be important to improve the response rate, especially in patients with predominant strictures.