Prognostic factors of response to endoscopic treatment in painful chronic pancreatitis

Abstract

AIMTo evaluate the endoscopic treatment efficacy and prognostic factors of long-term response to treatment for painful chronic pancreatitis.METHODSThis retrospective analysis identified 168 patients with painful chronic pancreatitis hospitalized during January 2010-January 2015 in a Romanian tertiary referral center. Data on demographics, medical history, alcohol consumption, smoking habit, clinical parameters, type and number of endoscopic procedures and hospital admissions number were collected from the medical charts and analyzed. The absence or substantial reduction of pain (mild pain) at the end of the follow-up associated with the technical success of endotherapy was considered as clinical success.RESULTSAmong the 168 patients with painful chronic pancreatitis admitted to our department during the study period, 39 (23.21%) had optimal response to the medical therapy. One hundred and twenty-nine patients required endoscopic treatment. The median follow-up period was 15 mo (range, 0-60 mo). Overall, technical success of endotherapy was achieved in 105 patients (81.39%). More than two-thirds of patients (82.78%) had substantial improvement of pain after the endoscopic treatment, including frequency and severity of the pain attacks. Patients younger than 40 years had significantly more successful endoscopic procedures (P = 0.041). Clinical success was higher in non-smoking patients (P = 0.003). The hospital admission rate was higher in patients with recognized alcohol consumption (P = 0.03) and in smokers (P = 0.027). The number and location of pancreatic stones and locations of strictures did not significantly influence the technical success (P > 0.05) or the clinical success (P > 0.05).CONCLUSIONYounger age than 40 years can be considered an important factor positively influencing endoscopic treatment outcome in patients with painful chronic pancreatitis.

Evidence-based clinical practice guidelines for chronic pancreatitis 2021

“…Furthermore, smoking was found to promote pancreatic calcification (RR 1.44, 95% CI 1.25-1.67; p \ 0.00001) [58][59][60][61][62][63][64] and to increase the risk of developing pancreatic exocrine dysfunction (RR 1.62, 95% CI 1.29-2.04, p \ 0.00001) and diabetes (RR 1.28, 95% CI 1.10-1.48; p = 0.001) in a meta-analysis of seven observational studies of pancreatic calcification (n = 2953), four observational studies of pancreatic exocrine dysfunction (n = 1331), and five observational studies of diabetes (n = 2254) [58][59][60][61][62][63][64][65]. In a meta-analysis of two observational studies, smoking also worsened the long-term prognosis after endoscopic treatment in patients with painful CP (RR 4.73, 95% CI 2.15-10.40; p = 0.0001) [66,67]. In contrast, a meta-analysis of five observational studies showed that smoking cessation had the effect of suppressing the onset of CP (RR 0.58, 95% CI 0.51-0.67; p \ 0.00001) [51][52][53][54][55].…”

Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis

“…Other studies with small sample sizes identified smoking, alcohol, incomplete stone removal, lesser narcotic use, pancreas divisum, and MPD stricture as predictive factors of persistent pain using univariate analysis [7,8,10,11,17,18]. Absence of multivariate analysis along with small samples in these studies could not identify independent predictors of persistent pain in patients with chronic calcific pancreatitis.…”

Turkish Gastroenterology Association, Pancreas Study Group, Chronic Pancreatitis Committee Consensus Report

“…In the same group, the need for surgery was 14% to 31% in patients with an average follow-up of less than 5 years, whereas it was 0% to 7.5% in those with a minimum average follow-up of 5 years (218,274,277,280,289,291,294). Factors favoring long-term pain response were absence of continuous pain before treatment, absence of daily narcotics use, short disease duration before treatment, absence of PD, absence of pain just before the procedure, no smoking, quitting alcohol, insertion of a 12F stent during treatment, resolution of the stricture after treatment, and improvement in the main duct diameter after treatment (275,277,278,284,285,291,293). Complications such as pancreatitis (6.3%), sphincterotomy bleeding (0.9%), sepsis (0.6%), cholangitis (0.4%), abscess (0.2%), stent migration (3.1%), and changes in the pancreatic duct (0.8%) may be observed during stenting treatment.…”