Endoscopic Therapy is an Effective Treatment for Chronic Pancreatitis
McGowan Institute for Regenerative Medicine affiliated faculty member David Whitcomb, MD, PhD, professor of medicine, cell biology and physiology, and human genetics at the University of Pittsburgh, chief of the Division of Gastroenterology, Hepatology, and Nutrition, as well as the founder and director of the Center for Genomic Sciences, and researchers at the University of Pittsburgh School of Medicine report that endoscopic therapy was found to be effective for patients with chronic pancreatitis. The team’s findings appear in the Journal of Clinical Gastroenterology and Hepatology.
Chronic pancreatitis is a progressive inflammatory disease characterized by abdominal pain and permanent damage to the pancreas. Pain associated with the condition is often a result of pancreatic duct obstruction from stones or strictures. Endoscopic therapy is a minimally invasive procedure to treat these obstructions, alleviating the pressure in the pancreatic duct, and ensuring adequate drainage of pancreatic secretions.
The researchers analyzed data on 146 patients enrolled in the North American Pancreatitis Study-2 to assess the utilization, effectiveness, and long-term clinical outcomes of endoscopic therapy and surgery in patients with chronic pancreatitis compared with those who were managed medically.
Abdominal pain, the most debilitating symptom for those with the disease, was present in two-thirds of patients, with over half of those describing the pain as constant and requiring daily narcotics. Among study participants, 58 percent underwent endoscopic therapy, 33 percent were managed medically, and 9 percent had surgery prior to the study. Of those who had endoscopic therapy, 33 percent later had surgery.
“Among those who were treated with endoscopic therapy, more than half had complete or partial long-term clinical success. Compared with those managed medically, patients undergoing endoscopic therapy were more symptomatic before treatment and had more complex disease. Of those patients who failed to improve after endoscopic therapy, half experienced good clinical outcomes following subsequent surgery,” said Dhiraj Yadav, M.D., M.P.H., lead author and associate professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh School of Medicine.
In addition, researchers found that the patients who responded to endoscopic therapy had the treatment sooner after diagnosis than those who didn’t respond to the therapy. This finding suggests that a degree of irreversibility develops as the disease progresses and may indicate a role for endoscopic or surgical intervention early in the disease course.
“Based on these findings, we propose a stepwise approach for managing chronic pancreatitis, starting with medical management. When indicated, patients should be considered for endoscopic therapy early in the disease course,” said Dr. Yadav. “A multidisciplinary, proactive approach is critical to controlling symptoms and disease progression in an effective, safe, and lasting manner.”
Abstract (Endoscopic therapy is effective for patients with chronic pancreatitis. Bridger Clarke, Adam Slivka, Yutaka Tomizawa, Michael Sanders, Georgios I. Papachristou, David C. Whitcomb, Dhiraj Yadav. Clinical Gastroenterology and Hepatology; Volume 10, Issue 7, Pages 795-802, July 2012.)