Elsevier

Pancreatology

Volume 20, Issue 2, March 2020, Pages 199-204
Pancreatology

Morphological advantages of endoscopic treatment in obstructive chronic pancreatitis

https://doi.org/10.1016/j.pan.2019.12.016Get rights and content

Abstract

Background

and study aims: Chronic pancreatitis is associated with recurrent or persistent abdominal pain over the course of the disease. Ductal hypertension showing obstructed and dilated pancreatic duct has been suggested as a major factor in the mechanism of pain in chronic pancreatitis. Many studies investigating pain relief after endoscopic treatment of pancreatic duct (PD) are available, but the number of studies regarding the morphological changes to pancreas such as changes in PD caliber, pancreatic parenchyma, and especially pancreatic volume is far fewer. As such, we analyzed the changes of ductal caliber and parenchymal volume after endoscopic treatment of PD in patients with obstructive chronic pancreatitis.

Patients and methods

In this retrospective study, we compared two groups of patients with obstructive chronic pancreatitis that either received endoscopic management of PD or conservative treatment without such endoscopic management. After we obtained age, sex, etiology of chronic pancreatitis, diabetic status, smoking and alcohol abuse status from the database, we compared the incidence for changes in pancreatic parenchymal volume and PD caliber between two groups.

Result

In our study population, total of 480 patients was diagnosed with chronic pancreatitis between January 2006 and December 2016, and 166 (34.5%) of these patients were diagnosed with obstructive chronic pancreatitis with obstructed and dilated PD. After reviewing the population with the exclusion criteria, 71 patients were available for the final analysis. 28 of those patient received endoscopic treatment of pancreatic duct and 43 received conservative treatment without any endoscopic treatment of PD. Statistical analysis with Cox proportional hazards models showed that diabetes and endoscopic PD management were significant predictors for progression of PD caliber and in pancreatic parenchyma, and that only PD management influenced the pancreatic volume loss.

Conclusion

Endoscopic management of PD in obstructive chronic pancreatitis have advantages on morphologic change such as pancreatic volume loss and progression of PD caliber in long follow-up period.

Introduction

Chronic pancreatitis is defined as chronic clinical disorder, pathologically characterized by the loss of exocrine pancreatic parenchyma, irregular fibrosis, cellular infiltration, and ductal abnormalities, which may also affect the endocrine function of pancreas in the advanced stage. Therapy in patients with painful chronic pancreatitis has been insufficient and remained a challenge, partly due to the fact that the mechanisms have not been fully understood [[1], [2], [3]]. Pain from chronic pancreatitis has been connected with various mechanisms such as perineural inflammation, increased pressure in the pancreatic duct (PD) and so on [2,4]. In case of ductal hypertension showing obstructed and dilated PD (i.e. obstructive chronic pancreatitis), decompression of duct would be effective treatment for pain of chronic pancreatitis. As method of ductal decompression, both surgical and endoscopic treatment are possible [1]. According to a number of studies, endoscopic treatment of obstructive chronic pancreatitis benefits approximately two thirds of cases [[5], [6], [7], [8]]. In most of these studies, however, only clinical outcomes such as pain relief, analgesic use, incidence of hospitalization and body weight were evaluated [[8], [9], [10], [11], [12], [13]] and the data on the structural changes after endoscopic treatment in obstructive chronic pancreatitis have been inadequate. To address this insufficiency of data, we performed a retrospective study investigating structural changes in pancreas in terms of change in caliber of main PD and parenchymal volume loss after endoscopic management of PD in obstructive chronic pancreatitis.

Section snippets

Patient

We retrospectively reviewed patients in a single hospital who had chronic pancreatitis with obstructed and dilated pancreatic duct. Patients were admitted between January 2006 and December 2016. Chronic pancreatitis with obstructed and dilated pancreatic duct is defined as a condition in which ductal and parenchymal hypertension, caused by an elevated pressure in the main pancreatic duct in presence of stricture, calculi, or both, is present. Our exclusion criteria is as follows: 1) history of

Methods

We reviewed patients’ records by using electronic medical records EMR) and a digitalized picture archiving communication system (PACS). The institutional review board at our institution which complies with the Helsinki declaration approved this study.

We studied two groups of patients with obstructive chronic pancreatitis that either received endoscopic treatment or conservative treatment without endoscopic management of pancreatic duct. Age, sex, etiology of chronic pancreatitis, status on

Baseline characteristics

A total of 480 patients were diagnosed chronic pancreatitis between January 2006 and December 2016, and 166 (34.5%) of these patients were diagnosed with obstructive chronic pancreatitis with obstructed and dilated PD. Of 166 patients with obstructive chronic pancreatitis, 60 followed up within 12 months or did not follow up at all, 6 had history of operation that was associated with pancreas, 1 was diagnosed with ampulla of Vater cancer, and 28 had severe parenchymal atrophy. Following our

Discussion

Chronic pancreatitis is associated with recurrent or persistent abdominal pain over the course of the disease. Ductal hypertension showing obstructed and dilated pancreatic duct has been suggested as a major factor in the mechanism of pain in chronic pancreatitis. Many studies about pain relief after endoscopic treatment of PD are available, but there has been little study about morphologic outcomes of pancreas in terms of PD caliber, pancreatic parenchyma, and especially pancreatic volume. To

Declaration of competing interest

The authors declare no vested interest that may have inappropriately influenced this study.

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