Increased Operative Difficulty and Poorer Outcomes after Multiple Endotherapies for Chronic Pancreatitis: An Analysis of 48 Consecutive Frey's Procedures

Abstract

Introduction: Chronic pancreatitis (CP) is being increasingly treated by endotherapy as part of the step-up approach. Multiple sessions of endotherapy have led to shrinking indications and delayed referrals for surgery. This study analyses the impact of multiple endotherapy sessions on difficulty of Frey's procedure and outcomes of surgery. Material and Methods: This prospective study included 48 consecutive Frey's procedures done for CP between 2016 and 2019 at our tertiary hepatopancreatobiliary centre. Demographic data, duration of CP, number of endotherapies [≥3 (group A) or < 3 (group B)], operative difficulty [operative time, intra-operative blood loss], pain relief [Visual Analog Scale (VAS)], and quality of life [EORTC-QLQ-C30 questionnaire (QoL score)] at 6 months were recorded. Results: 28 (58.33%) out of 48 patients were in group A, and 20 (41.67%) in group B. The mean operative time was 153.22±24.1 minutes in group A vs 138.33±15.29 minutes in group B (p< 0.05). The mean blood loss was 156.11±43.28 mL in group A compared to 116.04±34.42 mL in group B (p< 0.01). Improvement in VAS at 6 months was 3.22±0.83 in group A and 4.79±1.58 in group B (p< 0.01). Improvement in QoL score at 6 months was 36.44±9.34 in group A and 35.62±12.42 in group B (p=0.85). Conclusion: Multiple endotherapy sessions increase the operative time and intra-operative blood loss, thus increasing the operative difficulty, in addition to giving poorer pain relief. Early referral for surgery without subjecting patient to multiple endotherapies would improve operative and post-operative outcomes.OP04-21Correlation of number of endotherapies with operative difficulty and outcomesParameter≥3endotherapies (group A)<3 endotherapies (group B)p-valueNumber of patients28 (58.33%)20 (41.67%)Mean duration of surgery (minutes)153.22 ± 24.1138.33 ± 15.29<0.05*Mean blood loss (mL)156.11 ± 43.28116.04 ± 34.42<0.01*Change in VAS at 6 months3.22 ± 0.834.79 ± 1.58<0.01*Change in QoL score at 6 months36.44 ± 9.3435.62 ± 12.420.85 Open table in a new tab