Endoscopic management of early-stage chronic pancreatitis based on M-ANNHEIM classification system: a prospective study.
OBJECTIVE
The aim of this study was to evaluate the M-ANNHEIM classification system to categorize patients with chronic pancreatitis (CP).


METHODS
All symptomatic patients recruited from the gastroenterology outpatient clinic of Changhai Hospital (n = 89) were routinely evaluated by magnetic resonance cholangiopancreatography and contrast-enhanced computed tomography. M-ANNHEIM clinical staging was used to categorize patients. The primary outcome measure was pain during the 2-year follow-up period, expressed as mean Izbicki pain scores obtained before and after endotherapy.


RESULTS
There was a significant improvement in mean (SD) Izbicki pain scores obtained at 24 months among patients receiving endoscopic therapy at stage 1a compared with those at stage 1b (4.9 [3.0] vs 14.5 [6.9], P = 0.012). Furthermore, significantly more patients receiving endoscopic therapy at stage 1a achieved complete + partial pain relief after 2-year follow-up than those at stage 1b (95.2% vs 78.0%, P = 0.021). There was no exocrine or endocrine insufficiency, but a significantly greater number of patients treated at stage 1a had post-endoscopic retrograde cholangiopancreatography pancreatitis compared with those at stage 1b (10.5% vs 2.7%, P = 0.025).


CONCLUSIONS
We demonstrated that a sophisticated M-ANNHEIM classification system for CP will improve diagnosis by allowing for more timely intervention. Furthermore, prompt treatment of CP may achieve improved pain relief and patient outcomes.
From the *Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; †Department of Surgical Oncology, General Hospital of Chinese People's Liberation Army, Beijing, China; ‡Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China; and §Department of Gastroenterology, Fuzhou General Hospital, Fuzhou, China.
Yuan-Xiang
YX
He
Hong-Wei
HW
Xu
Xiao-Tian
XT
Sun
Zhou
Z
Ye
Wei
W
Wang
Xiao-Wei
XW
Lai
Xin-Tao
XT
Wang
Liang-Hao
LH
Hu
Chang
C
Sun
Zhuan
Z
Liao
Zhao-Shen
ZS
Li
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome