Spectrum of use and effectiveness of endoscopic and surgical therapies for chronic pancreatitis in the United States.
OBJECTIVE
This study aims to describe the frequency of use and reported effectiveness of endoscopic and surgical therapies in patients with chronic pancreatitis treated at US referral centers.


METHODS
Five hundred fifteen patients were enrolled prospectively in the North American Pancreatitis Study 2, where patients and treating physicians reported previous therapeutic interventions and their perceived effectiveness. We evaluated the frequency and effectiveness of endoscopic (biliary or pancreatic sphincterotomy, biliary or pancreatic stent placement) and surgical (pancreatic cyst removal, pancreatic drainage procedure, pancreatic resection, surgical sphincterotomy) therapies.


RESULTS
Biliary and/or pancreatic sphincterotomy (42%) were the most common endoscopic procedure (biliary stent, 14%; pancreatic stent, 36%; P < 0.001). Endoscopic procedures were equally effective (biliary sphincterotomy, 40.0%; biliary stent, 40.8%; pancreatic stent, 47.0%; P = 0.34). On multivariable analysis, the presence of abdominal pain (odds ratio, 1.82; 95% confidence interval, 1.15-2.88) predicted endoscopy, whereas exocrine insufficiency (odds ratio, 0.63; 95% confidence interval, 0.42-0.94) deterred endoscopy. Surgical therapies were attempted equally (cyst removal, 7%; drainage procedure, 10%; resection procedure, 12%) except for surgical sphincteroplasty (4%; P < 0.001). Surgical sphincteroplasty was the least effective (46%; P < 0.001) versus cyst removal (76% drainage [71%] and resection [73%]).


CONCLUSIONS
Although surgical therapies were performed less frequently than endoscopic therapies, they were more often reported to be effective.
From the *Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; †Department of Medicine, University of Pittsburgh, Pittsburgh, PA; ‡Digestive Disease Center, Medical University of South Carolina, Charleston, SC; §University of Michigan, Ann Arbor, MI; ∥Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA; ¶Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; #Department of Medicine, Wake Forest University Medical Center, Winston-Salem, NC; **Department of Medicine, Indiana University Medical Center, Indianapolis, IN; ††Department of Internal Medicine, St Louis University School of Medicine, St Louis, MO; ‡‡North Mississippi Medical Center, Tupelo, MS; §§Monterey Gastroenterology, Monterey, CA; and ∥∥Department of Medicine, University of Florida, Gainesville, FL.
Lisa M
LM
Glass
David C
DC
Whitcomb
Dhiraj
D
Yadav
Joseph
J
Romagnuolo
Elizabeth
E
Kennard
Adam A
AA
Slivka
Randall E
RE
Brand
Michelle A
MA
Anderson
Peter A
PA
Banks
Michele D
MD
Lewis
John
J
Baillie
Stuart
S
Sherman
Samer
S
Alkaade
Stephen T
ST
Amann
James A
JA
Disario
Michael
M
O'Connell
Andres
A
Gelrud
Christopher E
CE
Forsmark
Timothy B
TB
Gardner
D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D004724:Endoscopy / Q000009:adverse effects / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States