title: Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis.
abstract: This study aimed to determine if the improved pain response to endoscopic retrograde cholangiopancreatogrphy (ERCP) and pancreatic stent placement (EPS) predicts pain response in patients with chronic pancreatitis after modified lateral pancreaticojejunostomy (LPJ).
  
  
  
  A multi-institutional, retrospective review of patients who underwent successful EPS before LPJ between 2001 and 2010 was performed. The primary outcome was narcotic independence (NI) within 2 months after ERCP or LPJ.
  
  
  
  A total of 31 narcotic-dependent patients with chronic pancreatitis underwent successful EPS before LPJ. Ten (32%) achieved post-LPJ NI (median follow-up, 8.5 months; interquartile range [IQR], 2-38 months). Eight (80%) of 10 patients with NI post-ERCP achieved NI post-LPJ. Two (10%) without NI post-ERCP achieved NI post-LPJ. Narcotic independence post-EPS was associated strongly with NI post-LPJ with an odds ratio of 38 (P = 0.0025) and predicted post-LPJ NI with a sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 90.5%, 80%, and 90.5%, respectively.
  
  
  
  Narcotic independence after EPS is associated with NI after LPJ. Failure to achieve NI post-ERCP predicts failure to achieve NI post-LPJ. These results support the need for larger studies to confirm the predictive value of pancreatic duct stenting for better selection of chronic pancreatitis patients who will benefit from LPJ.
authors.affiliation: From the *Division of Gastroenterology, University of Michigan, Ann Arbor, MI; †Associates in Gastroenterology, Alexandria, VA; ‡Charleston Gastroenterology Specialists and §Summerville GI and Advanced Endoscopy, Charleston, SC; ‖Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; ¶Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA; #Division of Gastroenterology, Washington University, St. Louis, MO; **Division of Gastroenterology, Maine Medical Center, Portland, ME; ††Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and ‡‡Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Young
authors.forename: William F
authors.initials: WF
authors.lastname: Marsteller
authors.forename: Christopher
authors.initials: C
authors.lastname: Lawrence
authors.forename: Bechien U
authors.initials: BU
authors.lastname: Wu
authors.forename: Linda S
authors.initials: LS
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullady
authors.forename: David A
authors.initials: DA
authors.lastname: Klibansky
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
authors.forename: Diane M
authors.initials: DM
authors.lastname: Simeone
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D009294:Narcotics; D010183:Pancreatic Ducts; D010193:Pancreaticojejunostomy; D050500:Pancreatitis, Chronic; D012189:Retrospective Studies; D015607:Stents
chemical_list: D009294:Narcotics