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      • Management of Chronic Pancreatitis- Step Up?

        ( Peeyush Varshney ),( Rk Singh ),( Anu Behari ),( Ashok Kumar ),( Vk Kapoor ),( Rajan Saxena ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

        Aims: Endoscopic treatment is used in several units prior to surgical treatment for pain in chronic pancreatitis. There is limited information on patients who undergo surgical ‘salvage’ after endoscopic failure. We conducted a comparative study between patients who had undergone surgery after prior non-surgical intervention and upfront surgery. Methods: Patients who underwent surgical drainage in our institution over the last 6 years were reviewed, in two groups- Group A (n=29) - surgery with prior non-surgical interventions (ESWL and/or endoscopy); Group B (n=79) - upfront surgery. Pain scores and QOL scores were measured prospectively. Results: The two groups were comparable for baseline characteristics except that group A patients had more strictures/ stones in body and tail region (P<0.05). Short term morbidity was more in Group A vs Group B (65% vs 26%, P<0.01) - wound infection (45% vs 10%, P<0.01; Gastroparesis (10% vs nil, P<0.01). On long term followup complete pain relief was worse in Group A patients (37% vs 68%, P=0.05). Quality of life scores (WHOQOL- BREF) in social domain was significantly better in Group B. Improvement in exocrine and endocrine insufficiency was similar in both groups. Conclusions: Patients with chronic pancreatitis who undergo ‘salvage’ surgery after non-surgical interventions are at increased risk of postoperative morbidity, lower quality of life and poor pain control as compared to those who undergo upfront surgery. Patients with pancreatic body/tail strictures/ stones have poor outcomes with non-surgical interventions and may be considered for upfront surgery.

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