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Endoscopy 2002; 34(10): 765-771
DOI: 10.1055/s-2002-34256
Original Article
© Georg Thieme Verlag Stuttgart · New York

Endoscopic Treatment of Chronic Pancreatitis: A Multicenter Study of 1000 Patients with Long-Term Follow-Up

T.  Rösch 1 , S.  Daniel 1 , M.  Scholz 1 , K.  Huibregtse2 , M.  Smits 2 , T.  Schneider 3 , C.  Ell 3 , G.  Haber 4 , J.-F.  Riemann 5 , R.  Jakobs 5 , R.  Hintze 6 , A.  Adler 6 , H.  Neuhaus 1 , M.  Zavoral 7 , F.  Zavada 7 , V.  Schusdziarra 1 , N.  Soehendra 8 , for the European Society of Gastrointestinal Endoscopy Research Group
  • 1Dept. of Internal Medicine II and Dept. of Medical Statistics and Epidemiology, Technical University of Munich, Germany
  • 2Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  • 3Dept. of Internal Medicine I, Friedrich-Alexander University, Erlangen, Germany
  • 4Dept. of Gastroenterology, Wellesley Hospital, Toronto, Canada
  • 5Dept. of Medicine C, Ludwigshafen Hospital, Germany
  • 6Interdisciplinary Endoscopy Dept., Virchow University Hospital, Berlin, Germany
  • 7Dept. of Internal Medicine II, Central Military Hospital, Prague, Czech Republic
  • 8Dept. of Endoscopic Surgery, Eppendorf University Hospital, Hamburg, Germany
Weitere Informationen

Publikationsverlauf

Submitted: 15 January 2002

Accepted after Revision: 15 April 2002

Publikationsdatum:
23. September 2002 (online)

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Background and Study Aims: Endoscopic ductal decompression therapy has become an established method of treating patients with painful obstructive chronic pancreatitis. Smaller series, mostly with a medium-term follow-up period, have reported encouraging results. The present analysis presents long-term follow-up data from a large multicenter patient cohort.
Patients and Methods: Patients with painful chronic pancreatitis and with ductal obstruction due to either strictures and/or stones treated endoscopically at eight different centers underwent follow-up after 2 - 12 years (mean 4.9 years). The patients’ clinical data, the rate of technical success, and complications were recorded from the charts. Follow-up data were prospectively obtained using structured questionnaires; the main parameter for evaluating treatment success was a significant reduction in pain (no pain or only weak pain).
Results: Follow-up data were obtained from 1018 of 1211 patients treated (84 %) with mainly strictures (47 %), stones (18 %), or strictures plus stones (32 %). At the long-term follow-up, 60 % of the patients had their endotherapy completed, 16 % were still receiving some form of endoscopic treatment, and 24 % had undergone surgery. The long-term success of endotherapy was 86 % in the entire group, but only 65 % in an intention-to-treat analysis. There were no significant differences between the patient groups with regard to either strictures, stones, or both. Pancreatic function was not positively affected by endoscopic therapy.
Conclusions: Endoscopic ductal decompression therapy offers relief of pain in two-thirds of the patients when it is used as the only form of treatment. One-quarter of the patients have to undergo surgery.

  • 1 Ammann R W, Muellhaupt B. The natural history of pain in alcoholic chronic pancreatitis.  Gastroenterology. 1999;  116 1132-1140
    PubMedSuche in Google Scholar
  • 2 Di Magno E P. Toward understanding (and management) of painful chronic pancreatitis.  Gastroenterology. 1999;  116 1152-1257
    PubMedSuche in Google Scholar
  • 3 Blackstone M O. Pain in alcoholic chronic pancreatitis.  Gastroenterology. 1999;  117 1026-1028
    PubMedSuche in Google Scholar
  • 4 Grimm H, Meyer W H, Nam V C, Soehendra N. New modalities for treating chronic pancreatitis.  Endoscopy. 1989;  21 70-74
    Thieme ConnectPubMedSuche in Google Scholar
  • 5 Binmoeller K F, Jue P, Seifert H. et al . Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: Long-term results.  Endoscopy. 1995;  27 638-644
    Thieme ConnectPubMedSuche in Google Scholar
  • 6 Cremer M, Devière J, Delhaye M. et al . Stenting in severe chronic pancreatitis: Results of medium-term follow-up in seventy-six patients.  Endoscopy. 1991;  23 171-176
    PubMedSuche in Google Scholar
  • 7 Delhaye M, Vandermeeren A, Baize M, Cremer M. Extracorporeal shock-wave lithotripsy of pancreatic calculi.  Gastroenterology. 1992;  102 610-620
    PubMedSuche in Google Scholar
  • 8 Dumonceau J M, Devière J, LeMoine O. et al . Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: Long-term results.  Gastrointest Endosc. 1996;  43 547-555
    PubMedSuche in Google Scholar
  • 9 Smits M E, Badiga S M, Rauws E AJ. et al . Long-term results of pancreatic stents in chronic pancreatitis.  Gastrointest Endosc. 1995;  42 461-467
    CrossrefPubMedSuche in Google Scholar
  • 10 Smits M E, Rauws E AJ, Tytgat G NJ, Huibregtse K. Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis.  Gastrointest Endosc. 1996;  43 556-560
    PubMedSuche in Google Scholar
  • 11 Schneider H T, May A, Benninger J. et al . Piezoelectric shock wave lithotripsy of pancreatic duct stones.  Am J Gastroenterol. 1994;  89 2042-2048
    PubMedSuche in Google Scholar
  • 12 Löhr M, Schneider M, Farnbacher M. et al . Endoskopisch interventionelle Therapie der chronischen Pankreatitis.  Z Gastroenterol. 1997;  35 437-448
    PubMedSuche in Google Scholar
  • 13 Adamek H E, Jakobs R, Buttmann A. et al . Long-term follow-up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock-wave lithotripsy.  Gut. 1999;  45 402-405
    Suche in Google Scholar
  • 14 Sherman S, Lehman G A, Hawes R H. et al . Pancreatic ductal stones: Frequency of successful endoscopic removal and improvement in symptoms.  Gastrointest Endosc. 1991;  37 511-517
    PubMedSuche in Google Scholar
  • 15 Dite P, Zboril V, Cikankova E. Endoscopic therapy of chronic pancreatitis.  Hepatogastroenterology. 1996;  43 1633-1637
    PubMedSuche in Google Scholar
  • 16 Laugier R, Renou C. Endoscopic ductal drainage may avoid resective surgery in painful chronic pancreatitis without large ductal dilatation.  Int J Pancreatol. 1998;  23 145-152
    PubMedSuche in Google Scholar
  • 17 Ponchon T, Bory R M, Hedelius F. et al . Endoscopic stenting for pain relief in chronic pancreatitis: Results of a standardized protocol.  Gastrointest Endosc. 1995;  42 452-456
    Suche in Google Scholar
  • 18 van der Hul R, Plaisier P, Jeekel J, Terpstra O, den Toom R, Bruining H. Extracorporeal shock-wave lithotripsy of pancreatic duct stones: Immediate and long-term results.  Endoscopy. 1994;  26 573-578
    PubMedSuche in Google Scholar
  • 19 Costamagna G, Gabbrielli A, Mutignani M. et al . Extracorporeal shock-wave lithotripsy of pancreatic stones in chronic pancreatitis: Immediate and medium-term results.  Gastrointest Endosc. 1997;  46 231-236
    Suche in Google Scholar
  • 20 Hammarström L E, Stridbeck H, Ihse I. Endoscopic drainage in benign pancreatic disease: Immediate and medium term outcome.  Eur J Surg. 1997;  163 577-589
    PubMedSuche in Google Scholar
  • 21 Kozarek R A, Patterson D J, Ball T J, Traverso L W. Endoscopic placement of pancreatic stents and drains in the management of pancreatitis.  Ann Surg. 1989;  209 261-266
    CrossrefPubMedSuche in Google Scholar
  • 22 Kozarek R A, Ball T J, Patterson D J. Endoscopic approach to pancreatic duct calculi and obstructive pancreatitis.  Am J Gastroenterol. 1992;  87 600-603
    PubMedSuche in Google Scholar
  • 23 Schreiber F, Gurakuqi G CH, Pristauz H. et al . Sonographically-guided extracorporeal shock-wave lithotripsy for pancreatic stones in patients with chronic pancreatitis.  J Gastroenterol Hepatol. 1996;  11 247-251
    PubMedSuche in Google Scholar
  • 24 Wolf J S , Nakada S Y, Aliperti G, Edmundowicz S A, Clayman R V. Washington University experience with extracorporeal shock-wave lithotripsy of pancreatic duct calculi.  Urology. 1995;  46 638-642
    CrossrefPubMedSuche in Google Scholar
  • 25 Sauerbruch T, Holl J, Sackmann M, Paumgartner G. Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: A prospective follow-up study.  Gut. 1992;  33 969-972
    CrossrefPubMedSuche in Google Scholar
  • 26 Linder S, Engström C F, von Rosen A, Wiechel K L. Endoscopic clearance of the pancreatic duct in chronic pancreatitis with severe pain.  Surg Endosc. 1993;  7 37-41
    CrossrefPubMedSuche in Google Scholar
  • 27 McCarthy J, Geenen J E, Hogan W J. Preliminary experience with endoscopic stent placement in benign pancreatic diseases.  Gastrointest Endosc. 1988;  34 16-18
    CrossrefPubMedSuche in Google Scholar
  • 28 Gulliver D J, Edmunds S, Baker M E. et al . Stent placement for benign pancreatic diseases: Correlation between ERCP findings and clinical response.  AJR Am J Roentgenol. 1992;  159 751-755
    PubMedSuche in Google Scholar
  • 29 Ohara H, Hoshino M, Hayakawa T. et al . Single application extracorporeal shock-wave lithotripsy is the first choice for patients with pancreatic duct stones.  Am J Gastroenterol. 1996;  91 1388-1394
    PubMedSuche in Google Scholar
  • 30 Niederau C, Grendell J H. Diagnosis of chronic pancreatitis.  Gastroenterology. 1985;  88 1973-1995
    PubMedSuche in Google Scholar
  • 31 Passoni G GR, Santambrogio R, Arcidiacono P G. et al . Accuracy of echoendoscopy (EUS) and laparoscopic ultrasound (LUS) in the preoperative evaluation of pancreatic cancer [abstract].  Gastrointest Endosc. 1999;  49 AB97
    PubMedSuche in Google Scholar
  • 32 Prinz R A. Surgical drainage procedures. In: Howard JM, Idezuki Y, Ihse I, Prinz RA (eds) Surgical diseases of the pancreas. 3rd ed. Baltimore; Williams and Wilkins 1998: 359-366
    Suche in Google Scholar
  • 33 Prinz R A. Pancreatic duct drainage. In: Beger HG, Warshaw AL, Büchler MW et al. (eds) The pancreas. Oxford; Blackwell Science 1998: 829-836
    Suche in Google Scholar
  • 34 Greenlee H B, Prinz R A, Aranha G V. Long-term results of side-to-side pancreaticojejunostomy.  World J Surg. 1990;  14 70-76
    CrossrefPubMedSuche in Google Scholar
  • 35 Bradley E L. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis.  Am J Surg. 1987;  153 207-213
    CrossrefPubMedSuche in Google Scholar
  • 36 Taylor R H, Bagley F H, Braasch J W, Warren K W. Ductal drainage or resection for chronic pancreatitis.  Am J Surg. 1981;  141 28-33
    CrossrefPubMedSuche in Google Scholar
  • 37 Sarles J C, Nacchiero M, Garani F, Salasc B. Surgical treatment of chronic pancreatitis.  Am J Surg. 1982;  144 317-321
    CrossrefPubMedSuche in Google Scholar
  • 38 Lankisch P G, Löhr-Happe A, Otto J, Creutzfeld W. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease.  Digestion. 1993;  54 148-155
    CrossrefPubMedSuche in Google Scholar
  • 39 Beger H G, Schlosser W, Friess H M, Büchler M W. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease.  Ann Surg. 1999;  4 512-523
    PubMedSuche in Google Scholar
  • 40 Layer P, Yamamoto H, Kalthoff L. et al . The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis.  Gastroenterology. 1994;  107 1481-1487
    CrossrefPubMedSuche in Google Scholar
  • 41 Miyake H, Harada H, Kunichika K. et al . Clinical course and prognosis of chronic pancreatitis.  Pancreas. 1987;  2 378-385
    CrossrefPubMedSuche in Google Scholar
  • 42 Boerma D, van Gulik T M, Obertop H, Gouma D J. Does previous endoscopic stenting affect outcome of subsequent pancreaticojejunostomy for chronic pancreatitis? [abstract].  Gastroenterology. 2000;  118 A418
    PubMedSuche in Google Scholar

T. Rösch, M.D.

Dept. of Internal Medicine II · Technical University of Munich · Klinikum rechts der Isar

Ismaningerstrasse 22 · 81675 München · Germany ·

Fax: + 49-89-4140-4872

eMail: Thomas.Roesch@lrz.tu-muenchen.de