scholarly journals 556 A Prospective Review of Risk Factors, Clinical Presentation and Management Outcomes for Chronic Pancreatitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Akula ◽  
K Sugumar ◽  
A Deshpande
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Statistical Correlation ◽  
Pain Severity ◽  
Female Ratio ◽  
Pain Scores ◽  
Duct Diameter ◽  
Imaging Characteristics

Abstract Aim and objectives: To identify the risk factors, symptoms, and severity of Chronic pancreatitis (CP) on admission. To determine the relationship between pancreatic duct diameter and severity of pain and to assess extent of pain relief achieved by medical, endoscopic, and surgical intervention. Method 75 patients with CP were admitted over 2 years. Data collected included etiology, symptoms, pain scores and CT/MRCP findings. Patients were classified into mild, moderate, and severe category according to Cambridge classification. Type and response to treatment was recorded. Statistical correlation of the pancreatic duct diameter and pain severity as well as the comparison of pain scores after medical, surgical and endoscopy was performed using Chi square test (p value <0.05) Results Median age of presentation of CP was 43 years. Male: female ratio was 3:1. Alcohol was the etiology in 66 %, 99% presented with pain, 65 % belonged to severe category. There was no statistical correlation between pain severity and duct diameter. Pain relief following medical management was 66 %, endoscopic - 73% and surgical - 83 %. There was no correlation between Cambridge classification and pain severity. There was no statistical difference between pain relief offered by either of the three modalities. However, there was a statistically significant correlation between duct diameter and type of intervention. Conclusions There is no consensus on the best treatment modality for CP as pain relief was equivalent amongst all the modalities. Therefore, the choice of intervention for patients suffering from chronic pancreatitis should be based on imaging characteristics and symptomology.

Complications After Pancreaticoduodenectomy for Pancreatic Cancer: A Retrospective Study

2011 ◽  
Vol 96 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Shiyan Ren ◽  
Peng Liu ◽  
Ningxin Zhou ◽  
Jiahong Dong ◽  
Rong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
Univariate Analysis ◽  
Postoperative Hemorrhage ◽  
Morbidity Rate ◽  
Surgical Time ◽  
Pancreatic Cancers ◽  
Duct Diameter ◽  
Independent Risk Factors ◽  
Abdominal Hemorrhage

Abstract Postoperative complications, such as pancreatic fistulae, after pancreaticoduodenectomy for pancreatic cancers are associated with surgical outcomes of patients with pancreatic cancers. A total of 160 patients with pancreatic cancers undergoing pancreaticoduodenectomy were retrospectively analyzed. Patients were grouped into a fistulae group (n  =  34) and a nonfistulae group (n  =  126). The fistulae group had a significantly higher morbidity rate than the nonfistulae group (P < 0.0001), but hospital mortality was not different in both groups (P  =  0.481). There was a higher incidence of intra-abdominal hemorrhage in patients with pancreatic fistulae than in those without fistulae. Two patients in fistulae group underwent reoperation. Patients with pancreatic fistulae had significantly longer hospital stay than those without fistulae. Pancreatic duct diameter, smoking, years of tobaccos consumption, preoperative jaundice, and surgical hours were associated with risk of fistulae on univariate analysis. In a multivariate analysis, diameter of pancreatic duct, surgical hours, and preoperative jaundice were independent risk factors of pancreatic fistulae. Incidence of pancreatic fistulae after pancreaticoduodenectomy is significantly influenced by the size of pancreatic duct diameter, surgical time, and preoperative jaundice. Early postoperative hemorrhage could be cautiously prevented. The survival is not significantly impacted by pancreatic fistulae.

scholarly journals Evidence-based pancreatology 2016–2017 (review of results of research on chronic pancreatitis)

2017 ◽  
Vol 36 (2) ◽  
pp. 5-10
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
P. G. Fomenko ◽  
E. V. Berezhnaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Insufficiency ◽  
Pancreatic Fibrosis ◽  
Evidence Based ◽  
Imaging Methods

The article reviews the European recommendations on diagnostics and treatment of chronic pancreatitis, pain relief upon chronic pancreatitis. The results of evidenceased studies on risk factors of functional pancreatic insufficiency in patients with chronic pancreatitis, assessments of the informative value of various imaging methods, treatment of pancreatic insufficiency, markers of pancreatic fibrosis are analyzed. A conclusion is drawn on the need for further conduction of evidence-based research.

scholarly journals Drainage procedures for small duct disease in chronic pancreatitis: a feasible option

2018 ◽  
Vol 5 (6) ◽  
pp. 2319
Author(s):  
Venkatarami Reddy Vutukuru ◽  
Raghavendra Rao R. V. ◽  
Varughese Mathai ◽  
Sarala Settipalli
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Intractable Pain ◽  
Disease Group ◽  
Preoperative Pain ◽  
Exocrine Insufficiency ◽  
Pain Scores ◽  
Small Duct ◽  
Lateral Pancreaticojejunostomy ◽  
Feasible Option

Background: Surgery is the treatment of choice for intractable pain in chronic pancreatitis (CP). Drainage procedures are indicated in large duct disease whereas resectional procedures for small duct disease. Aim of this study was to assess prospectively the feasibility of drainage procedures in patients with CP with small duct disease.Methods: All consecutive patients with CP with small duct disease were included in the study. All patients underwent surgical intervention (lateral pancreaticojejunostomy with head coring). Primary outcome measures were pain relief and morbidity. These outcomes were compared with patients with CP with large duct disease.Results: 114 patients with CP underwent surgery. Of these 24(21.05%) patients had CP with small duct disease and 90(78.95%) patients had large duct disease. Demographic profile of the two groups was comparable. Mean pain scores were similar (47.75±6.85 versus 51.38±7.40; p = 0.14). Patients with large duct disease had higher incidence of diabetes mellitus (44.44% versus 8.33%; p = 0.02), but exocrine insufficiency was similar. All patients had calcifications in both the groups. Mean intraductal pressures measured intraoperatively were significantly high in patients with large duct disease (22.99±5.65 versus 18.33±3.52; p = 0.001). Frequency of complications at presentation were similar in both the groups (p = 0.29). Surgery relieved pain in 21/24 (87.5%) patients with small duct disease and 82/90 (91.11%) patients with large duct disease. Mean post-operative pain scores in small duct disease group (7.50±9.61 versus 51.38±7.40; p <0.001) and large duct disease group (5.14±7.88 versus 47.75±6.85; p <0.001) were significantly reduced when compared to preoperative pain scores. Incidence of postoperative complications was similar in both groups (16.66% versus 14.44%).Conclusions: Drainage procedures (lateral pancreaticojejunostomy with head coring) is a feasible for CP patients with small duct disease with good pain relief. 

scholarly journals Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

2021 ◽  
Vol 28 (2) ◽  
pp. 33-45
Author(s):  
E. S. Drozdov ◽  
E. B. Topolnitskiy ◽  
S. S. Klokov ◽  
T. V. Dibina
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Study ◽  
Morphological Examination ◽  
Distal Pancreatic Resection ◽  
Duct Diameter

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

scholarly journals Pancreatic Configuration Index in Predicting Postoperative Pancreatic Fistula in a Tertiary Care Center in Nepal

2020 ◽  
Vol 18 (2) ◽  
pp. 172-177
Author(s):  
Surendra Shah ◽  
Bikal Ghimire ◽  
Sharma Paudel ◽  
Yogendra Prasad Singh
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Predictive Value ◽  
Care Center ◽  
Tertiary Care ◽  
Postoperative Pancreatic Fistula ◽  
University Teaching ◽  
Female Ratio ◽  
Duct Diameter ◽  
Additional Surgery

Background: Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula.Methods: This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancreatic fistula was evaluated.Results: Among 58 patients, 9 were excluded from study and 49 patients were included in the study. The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.1:1 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%.Conclusions: Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.Keywords: Pancreaticoduodenectomy; pancreatic configuration index; postoperative pancreatic fistula.

Su1716 Outcomes in Main Pancreatic Duct Endoscopic Drainage for Pain Relief in Patients With Chronic Pancreatitis: a Multicenter Experience

2014 ◽  
Vol 79 (5) ◽  
pp. AB378
Author(s):  
Ali Siddiqui ◽  
Elizabeth Ssebayigga ◽  
Harkirat Singh ◽  
Jonathan Gotfried ◽  
Thomas E. Kowalski ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Endoscopic Drainage

scholarly journals Risk Factors for Migration, Fracture, and Dislocation of Pancreatic Stents

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yoshiaki Kawaguchi ◽  
Jung-Chun Lin ◽  
Yohei Kawashima ◽  
Atsuko Maruno ◽  
Hiroyuki Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Stent Migration ◽  
Success Rates ◽  
Patient Factors ◽  
Minor Papilla ◽  
Stent Retrieval ◽  
Duct Stenosis ◽  
Pancreatic Sphincterotomy

Aim. To analyze the risk factors for pancreatic stent migration, dislocation, and fracture in chronic pancreatitis patients with pancreatic strictures.Materials and Methods. Endoscopic stent placements (total 386 times) were performed in 99 chronic pancreatitis patients with pancreatic duct stenosis at our institution between April 2006 and June 2014. We retrospectively examined the frequency of stent migration, dislocation, and fracture and analyzed the patient factors and stent factors. We also investigated the retrieval methods for migrated and fractured stents and their success rates.Results. The frequencies of stent migration, dislocation, and fracture were 1.5% (5/396), 0.8% (3/396), and 1.2% (4/396), respectively. No significant differences in the rates of migration, dislocation, or fracture were noted on the patient factors (etiology, cases undergoing endoscopic pancreatic sphincterotomy, location of pancreatic duct stenosis, existence of pancreatic stone, and approach from the main or minor papilla) and stent factors (duration of stent placement, numbers of stent placements, stent shape, diameter, and length). Stent retrieval was successful in all cases of migration. In cases of fractured stents, retrieval was successful in 2 of 4 cases.Conclusion. Stent migration, fracture, and dislocation are relatively rare, but possible complications. A good understanding of retrieval techniques is necessary.

scholarly journals Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Muhammad Haseeb Nawaz ◽  
Shahid Sarwar ◽  
Muhammad Arif Nadeem
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
Binary Logistic Regression ◽  
Primary Prophylaxis ◽  
P Value ◽  
Procedure Time ◽  
Chi Square ◽  
Female Ratio ◽  
Creative Commons

Objective: To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP. Methods: This is a placebo-based prospective study at Department of Medicine & Gastroenterology, Services Institute of Medical Sciences / Services Hospital, Lahore performed from January 2018 to June 2019. Patients were randomized to receive diclofenac suppository or glycerine suppository before ERCP. Both groups were compared for PEP using chi square x2 test while risk factors for PEP were determined using binary logistic regression. Results: Total of 165 patients with mean age 49.1(±15.2) and male to female ratio 1/1.6 (63/102) were included. Among 82 (49.7%) patients in diclofenac group, 8 (9.7%) developed pancreatitis while 19(22.9%) of 83(50.3%) in placebo group had PEP (p value 0.02). After multivariate analysis, age>45 years (p value 0.014, OR 3.2), Bilirubin >3 mg/dl (p value 0.004 OR 3.58), time to cannulation> 5 minutes (p value<0.000 OR 9.2), use of precut (p value< 0.000 OR 4.9), pancreatic duct cannulation (p value 0.000 OR 5.46) and total procedure time >30 minutes (p value 0.01 OR 3.92) were risk factors for PEP. Conclusion: Pre-procedure Diclofenac suppository reduces post-ERCP pancreatitis. Age > 45 years, serum bilirubin > 3 mg/dl, cannulation time > 5 minutes, use of precut, pancreatic duct cannulation and procedure time > 30 minutes are risk factors for post-ERCP pancreatitis. doi: https://doi.org/10.12669/pjms.36.3.1804 How to cite this:Nawaz MH, Sarwar S, Nadeem MA. Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1804 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals A clinical study on lateral pancreaticojejunostomy in a case of chronic pancreatitis

2021 ◽  
Vol 8 (5) ◽  
pp. 1617
Author(s):  
Suhas B. Manapure ◽  
Anil S. Munde ◽  
Ravibhushan J. Kasale ◽  
Pramod Lokare
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Pancreatic Duct ◽  
Anastomotic Leak ◽  
Pancreatic Insufficiency ◽  
Drainage Procedure ◽  
Health Care Centre ◽  
Lateral Pancreaticojejunostomy

Lateral pancreaticojejunostomy is a seldom performed procedure in a peripheral tertiary health care centre. Very few numbers of cases are reported that undergoes surgical procedures for chronic pancreatitis. We report a such rare case in our institute that undergone pancreatic drainage procedure. A 70 year old poor patient was admitted in our institute with a complaint of chronic abdominal pain, subsequently diagnosed to be having chronic pancreatitis with complications with pancreatic duct calculus. Pancreatic drainage procedure, lateral pancreaticojejunostomy was performed and we analysed for the outcome of the procedure with regards to pain relief, anastomotic leak, quality of life and return to work. Patient recovered well post-operatively, reported pain relief, suffered no anastomotic leak and experienced improved quality of life. Lateral pancreaticojejunostomy provides excellent surgical choice for patients of chronic pancreatitis with pancreatic duct calculus with acceptable rates of pain relief, morbidity and mortality, without worsening pancreatic insufficiency. 

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