TY - JOUR
T1 - Narcotic Independence after Pancreatic Duct Stenting Predicts Narcotic Independence after Lateral Pancreaticojejunostomy for Chronic Pancreatitis
AU - Kwon, Richard S.
AU - Young, Benjamin E.
AU - Marsteller, William F.
AU - Lawrence, Christopher
AU - Wu, Bechien U.
AU - Lee, Linda S.
AU - Mullady, Daniel
AU - Klibansky, David A.
AU - Gardner, Timothy B.
AU - Simeone, Diane M.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Objective This study aimed to determine if the improved pain response to endoscopic retrograde cholangiopancreatogrphy (ERCP) and pancreatic stent placement (EPS) predicts pain response in patients with chronic pancreatitis after modified lateral pancreaticojejunostomy (LPJ). Methods A multi-institutional, retrospective review of patients who underwent successful EPS before LPJ between 2001 and 2010 was performed. The primary outcome was narcotic independence (NI) within 2 months after ERCP or LPJ. Results A total of 31 narcotic-dependent patients with chronic pancreatitis underwent successful EPS before LPJ. Ten (32%) achieved post-LPJ NI (median follow-up, 8.5 months; interquartile range [IQR], 2-38 months). Eight (80%) of 10 patients with NI post-ERCP achieved NI post-LPJ. Two (10%) without NI post-ERCP achieved NI post-LPJ. Narcotic independence post-EPS was associated strongly with NI post-LPJ with an odds ratio of 38 (P = 0.0025) and predicted post-LPJ NI with a sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 90.5%, 80%, and 90.5%, respectively. Conclusions Narcotic independence after EPS is associated with NI after LPJ. Failure to achieve NI post-ERCP predicts failure to achieve NI post-LPJ. These results support the need for larger studies to confirm the predictive value of pancreatic duct stenting for better selection of chronic pancreatitis patients who will benefit from LPJ.
AB - Objective This study aimed to determine if the improved pain response to endoscopic retrograde cholangiopancreatogrphy (ERCP) and pancreatic stent placement (EPS) predicts pain response in patients with chronic pancreatitis after modified lateral pancreaticojejunostomy (LPJ). Methods A multi-institutional, retrospective review of patients who underwent successful EPS before LPJ between 2001 and 2010 was performed. The primary outcome was narcotic independence (NI) within 2 months after ERCP or LPJ. Results A total of 31 narcotic-dependent patients with chronic pancreatitis underwent successful EPS before LPJ. Ten (32%) achieved post-LPJ NI (median follow-up, 8.5 months; interquartile range [IQR], 2-38 months). Eight (80%) of 10 patients with NI post-ERCP achieved NI post-LPJ. Two (10%) without NI post-ERCP achieved NI post-LPJ. Narcotic independence post-EPS was associated strongly with NI post-LPJ with an odds ratio of 38 (P = 0.0025) and predicted post-LPJ NI with a sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 90.5%, 80%, and 90.5%, respectively. Conclusions Narcotic independence after EPS is associated with NI after LPJ. Failure to achieve NI post-ERCP predicts failure to achieve NI post-LPJ. These results support the need for larger studies to confirm the predictive value of pancreatic duct stenting for better selection of chronic pancreatitis patients who will benefit from LPJ.
KW - chronic pancreatitis
KW - endoscopic retrograde pancreatography
KW - lateral pancreaticojejunostomy
KW - pancreatic stent
KW - treatment outcomes
UR - http://www.scopus.com/inward/record.url?scp=84963961960&partnerID=8YFLogxK
U2 - 10.1097/MPA.0000000000000623
DO - 10.1097/MPA.0000000000000623
M3 - Article
C2 - 27088488
AN - SCOPUS:84963961960
SN - 0885-3177
VL - 45
SP - 1126
EP - 1130
JO - Pancreas
JF - Pancreas
IS - 8
ER -