Document Detail


Long-term clinical outcomes after endoscopic minor papilla therapy in symptomatic patients with pancreas divisum.
MedLine Citation:
PMID:  19672208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess the long-term outcomes of endoscopic minor papilla therapy in a spectrum of symptomatic patients with pancreas divisum. METHODS: Patients with pancreas divisum coded in a prospective database as having had minor papilla endotherapy (July 1997-May 2003, n = 145) were grouped into 3 categories: (1) acute recurrent pancreatitis, (2) chronic pancreatitis, and (3) chronic/recurrent epigastric pain. Telephone follow-up was conducted (78% of patients), including questions regarding interval co-interventions and narcotic use. Primary success was defined as clinical improvement (better or cured on a Likert scale), without needing narcotics, after 1 therapeutic endoscopic retrograde cholangiopancreatography. Fisher exact and Mann-Whitney U tests and multivariate logistic regression were used to identify predictors of success. RESULTS: Primary success rates in acute recurrent pancreatitis, chronic pancreatitis, and chronic/recurrent epigastric pain were achieved in 53.2%, 18.2%, and 41.4%, respectively; and secondary success rates (<or=2 additional endoscopic retrograde cholangiopancreatographies), 71.0%, 45.5%, and 55.2%, respectively (median follow-up, 43.0 months; range, 14-116 months). Younger age (median age, 46.5 years [no success] vs 58.0 years [success]; P < 0.0001) and chronic pancreatitis (odds ratio, 0.10; 95% confidence interval, 0.03-0.39; P = 0.001) independently predicted a lower chance of success. CONCLUSIONS: Significant long-term improvement can be achieved with endoscopic therapy in selected patients with pancreas divisum, although many require multiple procedures. Older patients, without chronic pancreatitis, were most likely to respond.
Authors:
Gregory D Borak; Joseph Romagnuolo; Mohammad Alsolaiman; Edward W Holt; Peter B Cotton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pancreas     Volume:  38     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-26     Completed Date:  2010-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  903-6     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina, Charleston, SC 29425, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / surgery
Acute Disease
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde / methods*
Female
Follow-Up Studies
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care) / methods,  statistics & numerical data
Pancreas / abnormalities*,  surgery*
Pancreatitis / surgery
Pancreatitis, Chronic / surgery
Recurrence
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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