Amitasha Sinha1, Yuval A Patel1, Michael Cruise2, Karen Matsukuma2, Atif Zaheer3,4, Elham Afghani1, Dhiraj Yadav5, Martin A Makary6,4, Kenzo Hirose6,4, Dana K Andersen7, Vikesh K Singh8,9. 1. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 2. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 3. Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 4. Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 5. Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 6. Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 7. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA. 8. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu. 9. Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. vsingh1@jhmi.edu.
Abstract
BACKGROUND: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. METHODS: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. RESULTS: A total of 60 patients (age 51.6 years, 53% males) were included in our study, of whom 42 (70%) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62%) patients with toxic etiology, 36 (60%) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95% CI 1.3, 24.5, p = 0.02). CONCLUSION: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.
BACKGROUND: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CPpatients undergoing the Whipple or Frey procedure. METHODS: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. RESULTS: A total of 60 patients (age 51.6 years, 53% males) were included in our study, of whom 42 (70%) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62%) patients with toxic etiology, 36 (60%) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95% CI 1.3, 24.5, p = 0.02). CONCLUSION: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CPpatients undergoing the Whipple or Frey procedure.
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Authors: Aliye Uc; Dana K Andersen; Melena D Bellin; Jason I Bruce; Asbjørn M Drewes; John F Engelhardt; Christopher E Forsmark; Markus M Lerch; Mark E Lowe; Brent A Neuschwander-Tetri; Stephen J OʼKeefe; Tonya M Palermo; Pankaj Pasricha; Ashok K Saluja; Vikesh K Singh; Eva M Szigethy; David C Whitcomb; Dhiraj Yadav; Darwin L Conwell Journal: Pancreas Date: 2016-11 Impact factor: 3.327