Outcomes of Interventional ERCP in Hereditary Pancreatitis

Abstract

To clinically evaluate the patients with hereditary pancreatitis (HP) before the first, after the first and last interventional endoscopic retrograde cholangiopancreatography (ERCP), and at follow-up. There are limited data evaluating the outcomes and role of interventional ERCP in HP. Between 1990 and 2008, 21 consecutive patients with HP were retrospectively assessed for response to therapeutic ERCP. Medical records were reviewed and a telephone survey was conducted to obtain information. Patients underwent a total of 87 interventional ERCPs (mean 4, range: 1 to 11) and were followed-up for a mean period of 5 years (2 to 212 mo) from the last ERCP. The mean age at diagnosis, first ERCP, and follow-up was 15, 19, and 27 years (2 to 39 y), respectively. Eleven of 12 patients (92%) who received surgical therapy required subsequent interventional ERCPs. Before and after first ERCP mean pain scores decreased from 8.3 to 3.2 (P=0.001) and after last ERCP scores decreased to 2.7 (P=0.001). Yearly hospital visits including urgent care and emergency room visits decreased from 5.7 to 1.9 (P<0.001) and then to 1.6 (P=0.001). Daily oxycodone equivalent usage decreased from 39 to 34 mg (P=0.7) and then to 9.4 mg (P=0.05). Complications included pancreatitis in 3% with no perforations, bleeding, or infection. Despite decompressive or resective surgeries in 12 of 21 patients, the majority (92%) developed subsequent complications and required endoscopic therapy. Endoscopic management for amenable lesions often requires multiple ERCPs. Interventional ERCPs in patients with HP is associated with decreased pain, analgesic usage, hospitalizations, and episodes of recurrent pancreatitis.