Multimodality Treatment of Chronic Pancreatitis: Can We Prevents Hospital Admission?

Abstract

Background & Aims: Efficacy of endoscopic therapy for chronic pancreatitis (CP) has typically been evaluated by improvement in pain score. Unfortunately accurate evaluation of pain is difficult since most patients are already on pain medication when undergoing endoscopic therapy. Our aim is to determine the efficacy of multimodality treatment of chronic pancreatitis on the rate of hospitalization. Methods: 247 patients (174 male, mean age 51 ± 13 y/o) with CP associated with pain were endoscopically treated between December 2001 and November 2006 and followed prospectively. Therapy offered included ERCP with pancreatic duct stenting (PD stent), extracorporeal shock wave lithotripsy (ESWL), and celiac plexus block (CPB). Long term efficacy of therapy was based on the absence of recurrent admissions for abdominal pain or pancreatitis after therapy, excluding post-procedural admission. Multivariate analysis were effected on the following factors to assess prediction of successful treatment (Age (<55 versus ≥55 y/o), gender, etiology (alcoholic or not), PD stent (yes versus no), ESWL, CPB). Results: Therapy included a mean of 3.6 ± 2.9 ERCPs in 240 (97%) patients with 166 (67%) patients receiving a PD stent, 37 (15%) patients underwent a mean of 1.2 ± 0.7 ESWL (range 1-4) and 42 (17%) patients received a mean of 2.2 ± 2 CPB (range: 1-8). A total of 154 (62%) patients did not require further admission post therapy over a median period of three years (range:1-5). Multivariate logistic regression analysis identified only PD stent as a predictor of long term success (see table). Conclusions: Endoscopic treatment of chronic pancreatitis is efficacious in 62% of patients undergoing multimodality therapy. PD stent placement appears to be a predictor of success in preventing long -term hospitalization post therapy. Tabled 1Predictive factor of successful treatment Factors P value Odds ratio 95% CI Gender 0.970 1.01 0.53-1.93 Age 0.051 1.77 1.00-3.13 Etiology 0.292 0.72 0.38-1.33 PD stent 0.007 0.43 0.24-0.79 ESWL 0.807 0.91 0.44-1.90 CPB 0.293 0.68 0.33-1.40 Open table in a new tab