Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis.
OBJECTIVE
Endotherapy for patients with painful chronic pancreatitis (CP) gives early and midterm clinical results comparable with those of conventional surgery. The authors evaluated long-term clinical outcome after endoscopic pancreatic ductal drainage, focusing on pain and pancreatic endocrine/exocrine functions.


METHODS
Of 110 patients with painful CP endoscopically treated between October 1987 and December 1989, 56 long-surviving patients were followed-up for 14.4 years (SD, .6 y); 40 patients died and 14 patients were lost to follow-up evaluation. Technical results included decreased ductal dilation and stone clearance. Clinical results included the rate of hospitalizations for pain before and after endotherapy, the need for surgery, the course of endocrine/exocrine insufficiencies, and late mortality.


RESULTS
Complete or partial technical success initially was obtained in 48 of 56 long-surviving patients. Long-term clinical success (< or =5 hospitalizations for pain during follow-up evaluation, without surgery) was obtained for 37 of 56 patients. At a mean follow-up time of 14.4 years, 44 patients had avoided surgery and the annual rate of hospitalizations for pain decreased significantly (before endotherapy: 0.98 [+/-1.36] vs 0.40 [+/-0.51] for the 3 years thereafter vs 0.14 [+/-0.22] for the last 11 years of follow-up evaluation; P < .001). Short duration of disease before initial therapy and absence of smoking at the last follow-up evaluation were associated with long-term clinical success.


CONCLUSIONS
Endotherapy provides long-term benefits for about two thirds of patients with painful CP. Good clinical outcome was associated with cessation or absence of smoking, whereas alcohol abuse increased the risks for diabetes mellitus, steatorrhea, and mortality.
Delhaye
Myriam
M
Medicosurgical Department of Gastroenterology, Erasme University Hospital, 1070 Brussels, Belgium. mydelhay@ulb.ac.be
Arvanitakis
Marianna
M
Verset
Gontran
G
Cremer
Michel
M
Devière
Jacques
J
D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D001530:Belgium / Q000453:epidemiology; D002137:Calculi / Q000601:surgery; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000453:epidemiology; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008096:Lithotripsy; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010182:Pancreatic Diseases / Q000601:surgery; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000150:complications / Q000628:therapy*; D012907:Smoking / Q000009:adverse effects; D045602:Steatorrhea / Q000453:epidemiology