title: Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis.
abstract: OBJECTIVE
  Patients with chronic pancreatitis usually have a long and debilitating history of disease with frequent hospital admissions, episodes of intractable pain and multiple interventions. The sequences of treatment at initial presentation, endoscopy, surgery, or conservative treatment may affect the time course and admissions needed for disease control, thereby determining quality of life and overall outcome.
  
  
  METHODS
  A total of 292 patients with initial endoscopic, surgical, or conservative pharmacological treatment were retrospectively analyzed regarding frequency of interventions, days in hospital, symptom-free intervals, morbidity, and mortality. Quality of life (QoL) at the latest follow-up was measured by two standardized quality of life questionnaires (EORTC C30 and PAN26).
  
  
  RESULTS
  Endoscopic treatment was initially performed in 150 (51.4%) patients, whereas 99 (33.9%) underwent surgery and 43 (14.7%) patients were treated conservatively at their initial presentation. Patients who underwent surgery had a significantly shorter time in the hospital (25.3 ± 24.6, 34.4 ± 35.1, 61.1 ± 37.9; P < 0.001), fewer subsequent therapies (0.43 ± 1.0, 2.1 ± 2.4, 3.1 ± 3.0; P ≤ 0.001), and a longer relapse-free interval (P = 0.004) compared with endoscopically treated patients. The overall complication rate was 32% both after surgery and endoscopy. Infectious-related complications occurred more often after surgical treatment (P ≤ 0.001), whereas patients after endoscopic intervention developed acute or chronic pancreatitis or pseudocyst formation (P = 0.023).
  
  
  CONCLUSIONS
  Patients who undergo surgery as their initial treatment for chronic pancreatitis require less consecutive interventions, a shorter hospital stay, and have a better quality of life compared with any other treatment. Surgery should therefore be considered early for the treatment of chronic pancreatitis, when endoscopic or conservative treatment fails and patients require further intervention.
authors.affiliation: Department of Internal Medicine III (Division of Gastroenterology and Hepatology), Medical University of Vienna, General Hospital, Vienna, Austria.
authors.forename: Karoline
authors.initials: K
authors.lastname: Rutter
authors.forename: A
authors.initials: A
authors.lastname: Ferlitsch
authors.forename: T
authors.initials: T
authors.lastname: Sautner
authors.forename: A
authors.initials: A
authors.lastname: Püspök
authors.forename: P
authors.initials: P
authors.lastname: Götzinger
authors.forename: A
authors.initials: A
authors.lastname: Gangl
authors.forename: M
authors.initials: M
authors.lastname: Schindl
mesh_terms: D000328:Adult; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome