Surgical management of failed endoscopic treatment of pancreatic disease.
BACKGROUND
Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms.


OBJECTIVE
Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery.


METHODS
Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%).


RESULTS
Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common.


CONCLUSIONS
These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.
Evans
Kimberly A
KA
Division of General Surgery, Department of Surgery, University of Florida, P.O. Box 100286, 1600 SW Archer Road, Gainesville, FL 32610, USA.
Clark
Colby W
CW
Vogel
Stephen B
SB
Behrns
Kevin E
KE
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome