Population based, prospective study of the care of women with epilepsy in pregnancy

Abstract

<h3>Introduction</h3> Chronic pancreatitis (CP) is a fibroinflammatory condition of the pancreas leading to pancreatic fibrosis, duct distortion and calcification with progressive pain, exocrine and endocrine dysfunction. We sought to assess the effects of endoscopic intervention via Endoscopic Retrograde Cholangiopancreatography (ERCP) on pancreatic duct (PD) remodelling and pain. <h3>Methods</h3> Consecutive patients with CP who underwent ERCP with pancreatic intervention at a tertiary centre over a ten-year period were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and follow-up data. Fishers test was used to calculate statistical significance. <h3>Results</h3> 51 patients (36 male) with PD strictures and intraductal calcification were identified. The median age was 50 (range 20 – 82 years old). 131 ERCPs were undertaken (one procedure in 23, two- three in 19, four- five in 3, six and above in 6). Alcohol was the commonest aetiology in 39.22% (n=20), followed by idiopathic 25.5% (n=13) and obstructive stone disease 21.57% (n=11). 43.14% (n=22) were smokers and 41.18% (n=21) were consuming alcohol. Technical success was achieved in 84.31% (n=43). 72.09% (n= 31) had a main PD stricture. 62.79% (n= 27) had main PD stones of which 33.33% (n=9) were larger than 5mm. 88.37% (n=38) underwent pancreatic endotherapy. Dilatation of pancreatic strictures was carried out in 44.74% (n=17), with 94.74% (n=36) undergoing pancreatic stenting. Sequential pancreatic stenting was utilised in 66.16% (n=24). In total there were 81 stents inserted over the study period. Plastic stents were the most commonly used at 62.96% (n=51), followed by Niti-S™ BUMPY™ Pancreatic Stent 30.86% (n=25) and Fully Covered Self Expanding Metal stents (FC-SEMS) 4.94% (n=4) and one ARCHIMEDES Biodegradable pancreatic stent. The median duration of sequential stenting was 17 months (range 1- 65 months). 42.11% (n=16) had resolution of their strictures with intervention and 57.89% (n=22) had improvement in pain. Patients with intraductal stones &lt;5mm were more likely to have improvement in pain with endoscopic therapy than those &gt;5mm (15 vs 2, P= 0.0001). Patients having sequential stenting were more likely to have improvement in their strictures (14 vs 2, p= 0.0157). The same effect on pain was not apparent with sequential stenting (17 vs 7, p= 0.2979). There were 2 episodes of pancreatitis and 6 episodes of stent migration. <h3>Conclusions</h3> Pancreatic endotherapy is more effective in patients with intraductal stones less than 5mm. Sequential stenting seems to have a beneficial effect on pancreatic strictures which may impact disease progression.