Long-term follow-up of endoscopic stenting in patients with chronic pancreatitis secondary to pancreas divisum.
BACKGROUND
Pancreas divisum is the most common anatomic variant of pancreatic development and may lead to pancreatitis. This study evaluated the efficacy of endoscopic stenting in patients with chronic pancreatitis due to pancreas divisum.


METHODS
Between 1993 and 2005, 32 patients with chronic pancreatitis due to pancreas divisum were treated with endoscopic stenting. Each patient underwent an endoscopic retrograde cholangiopancreatography to confirm the diagnosis of pancreas divisum prior to endoscopic stenting. A survey was conducted by telephone conversation to evaluate pain intensity, symptom relief, hospital admissions, quality of life and pain medication usage, which was verified by a statewide narcotic electronic database. Eight of the 32 patients were unavailable for the interview and were not included in the analysis of the study. Results are expressed as mean +/- standard error of the mean (SEM).


RESULTS
Twenty-four patients were followed up for a period of 59.6 months. The overall pain level average in the 24 patients decreased significantly from 8.9 +/- 0.4 pre-stenting to 3.9 +/- 0.7 post-stenting (P < 0.05) on a scale of 1 to 10. The number of hospital admissions per year in these patients decreased significantly from 7.3 +/- 2.1 pre-stenting to 2.1 +/- 0.4 post-stenting (P < 0.05). Pain medication usage reported by the patients found a decrease in 58% of patients, 21% remained the same, and 13% increased their usage. There was improvement in nausea (67%), vomiting (63%), and chronic pain (75%). Thirteen patients (55%) were treated endoscopically without requiring surgery and 11 (45%) patients required surgery after stenting. These 11 patients had surgery an average of 25 months post-stenting. The complication rate of post-procedural pancreatitis was 3.4%. No mortality was reported in this study.


CONCLUSIONS
Endoscopic stenting of the pancreatic duct is a safe and effective first treatment for patients with pancreatitis secondary to pancreas divisum. Surgery, when performed for endoscopic stenting failure, is effective as an adjunctive treatment.
Vitale
Gary C
GC
Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA. gcvita01@earthlink.net
Vitale
Michael
M
Vitale
David S
DS
Binford
John C
JC
Hill
Ben
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000150:complications / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D019233:Retreatment; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome
D000700:Analgesics