Joshua S Tierney1, Neal Bhutiani, MD2, Amber N Brown2, John S Richey, MD2, Michael Bahr, MD2, Gary C Vitale, MD2. 1University of Colorado Health, 2University of Louisville
Introduction: The objective of this study was to identify factors that predict success or failure of ERCP for treatment of relapsing pancreatitis in pancreas divisum (PD).
Methods: An IRB-approved database of patients undergoing ERCP at our institution from 2008-2016 was queried for patients with PD and pancreatitis. Patients were then grouped according to whether they required 1-2 ERCPs or three or more ERCPs. Groups were compared along demographic, diagnostic, laboratory, ERCP-related, and outcome variables (e.g. requirement for operative intervention, total number of hospitalizations). Univariate analysis was performed using two-sided t-tests for continuous variables and Fisher’s exact test for categorical variables.
Results: Of 1867 patients undergoing ERCP during the study period, 75 patients underwent at least one ERCP for management of relapsing pancreatitis secondary to PD. Of these, 25 (33%) required 1-2 ERCPs. Patients requiring 1-2 ERCPs and those requiring 3+ ERCPs did not differ significantly with respect to age (49±14 years vs. 45±13 years, p=0.25) or male gender (32% vs. 24%, p=0.47). With respect to presenting symptoms and imaging characteristics, patients requiring 1-2 ERCPs were less likely to have back pain on initial presentation than those requiring 3+ ERCPs (4% vs. 24%, p=0.02) and less likely to have a dilated bile duct on imaging prior to their first ERCP (8% vs. 30%, p=0.04). The groups did not differ with respect to pre-ERCP laboratory variables, placement of a pancreatic duct stent during initial ERCP, subjective abdominal pain after initial ERCP. Patients requiring 1-2 ERCPs were less likely to eventually require operative intervention for treatment of their chronic pancreatitis than those requiring 3+ ERCPs (24% vs. 44%, p=0.047) (Table 1). On multivariable analysis when controlling for age, gender, initial symptoms, hospitalizations prior to initial ERCP, and ductal characteristics on initial imaging, a dilated bile duct (OR = 6.0, 95% CI = 1.01-36.0, p=0.048) was independently associated with requiring 3+ ERCPs. Back pain (Odds ratio (OR) = 6.3, 95% confidence interval (CI) = 0.73-54.2, p=0.09) trended toward but did not reach statistical significance for being independently associated with requiring 3+ ERCPs.
Conclusions: The success of endoscopic treatment of relapsing pancreatitis in patients with PD is dependent on proper patient selection. Our data suggest that patients with a dilated bile duct and back pain upon presentation may not respond well to endoscopic treatment alone and are more likely to eventually require operative intervention. Consideration should be given to early operative intervention in these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85461
Program Number: S075
Presentation Session: Flexible Endoscopy Session
Presentation Type: Podium