title: Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct.
abstract: BACKGROUND
  The aim of endoscopic treatment in patients with chronic pancreatitis is to achieve decompression of the pancreatic duct, because duct obstruction with increased pressure within the duct is one of the leading causes of pain in these patients. The majority of patients suffer from relapsing pain, thus making it difficult to evaluate the efficacy of therapy. The outcome of endoscopic treatment on pain has been evaluated in patients with continuous pain (present for more than 1 month, at least 5 days per week, requiring daily analgesic therapy) and dilated duct.
  
  
  METHODS
  Of 343 patients who underwent endotherapy for chronic pancreatitis in a 15-year period, 22 (6.4%)(19 men, mean age 48 years, alcohol abuse 14) had continuous pain and a dilated pancreatic duct.
  
  
  RESULTS
  Endotherapy was successful in all patients, with no procedure-related mortality and only mild complications. Pain disappeared, and analgesics could be discontinued in all patients immediately after endotherapy. Six patients are pain free after a mean period of 5.5 years. One pain-free patient died after 3.4 years from myocardial infarction. Five patients were successfully endoscopically re-treated for pain relapses. Four patients underwent surgery for frequent pain relapses after a mean period of 2.5 years. Six patients were lost to follow-up.
  
  
  CONCLUSIONS
  Endotherapy should be considered as the initial treatment of choice in patients with chronic pancreatitis, dilated duct, and continuous pain.
authors.affiliation: Digestive Endoscopy Unit, Università Campus Bio Medico, Rome, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Gabbrielli
authors.forename: Monica
authors.initials: M
authors.lastname: Pandolfi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mutignani
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Perri
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruzziello
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004108:Dilatation, Pathologic / Q000150:complications / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome