INTRODUCTION: Painful chronic pancreatitis (CP) is difficult to manage and the disease impacts patients’ emotional well-being and quality of life (QOL). Pancreatic endotherapy (PET) offers treatment for the sequelae of CP: pancreatic duct (PD) strictures, stones, and leaks. PET includes ERCP with pancreatic sphincterotomy, stent placement, lithotripsy and EUS-guided celiac plexus block to alleviate symptoms, manage complications, and potentially improve QOL. The aim of this study was to obtain a holistic understanding of how PET affects the QOL.

METHODS: The investigators at a single referral center reviewed clinic and endoscopy schedules to identify symptomatic CP subjects in whom PET was anticipated. Assessments included the standardized PANQOLI questionnaire (a CP-specific validated QOL instrument), the visual analog scale (VAS) for pain, and opioid usage quantified as Morphine Equivalent Dose (MED) for standardized comparison. Following informed consent, subjects were contacted to complete the QOL assessment prior to initial PET and at 1, 3, 6, and 12 month following index PET.

RESULTS: A total of 120 subjects, 58.3% female with a mean age of 52.3 (Table 1) reported a median of 4 CP exacerbations and 2 hospitalizations in the year prior to PET. Stenting and CPB were most frequently performed. Controlling for age, PET type, gender, race, education, smoking status, and CP duration, patients showed significant improvements in overall QOL, role function, and emotional function, at each follow-up time point in survey responders (Table 2). MED significantly decreased from baseline at each interval. Pain levels significantly improved at 1 and 6 months but the improvement did not remain sustained at 12 months.

CONCLUSIONS: 1) PET in a difficult to manage CP population was associated with significant improvement in QOL throughout the 12 month follow up period. 2) Opioid use consistently decreased with commencement of PET. 3) At one year of follow-up, the significant improvement in QOL compared to the lack of sustained improvement in pain assessments implies that pain is just one component of the patient’s overall health in CP. The VAS may be less meaningful given the improvement in overall QOL. 4) Further studies are needed to understand how PET affects specific facets of quality of life as well as the long term durability of PET.

Table 1. Demographics and disease characteristics of patients with CP (N=120)

Table 2. Changes in PANQOLI (overall quality of life), quality of life subdomains, pain, and morphine equivalent dose from baseline to 1 month, 3 months, 6 months, and 12 months post-endotherapy, controlling for age, endotherapy type, gender, race, education, smoking status, and disease duration (bolded differences were significantly different from baseline).

Anna Duloy

University of Colorado

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