Su1713 Endoscopic Therapy in Chronic Pancreatitis: What Are the Factors Associated With Successful Response ?

Su1713 Endoscopic Therapy in Chronic Pancreatitis: What Are the Factors Associated With Successful Response ? Monica Gaidhane*, Daniela GonzaLez-AVila, Barbara M. Figueroa E, Carlos M. Rondon Clavo, Reem Z. Sharaiha, Michel Kahaleh Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY Introduction: Chronic pancreatitis is a progressive and painful disease, caused by stricture formation, stone disease or pseudocyst formation. ERCP has been shown to be effective and safe for the treatment of chronic pancreatitis and permits sphincterotomy, stone extraction, ESWL, dilation, and stent placement. Technical success is about 85% and clinical success ranges from 70-90%, with relief of pain in 66% of cases. There is scarce published data on predictor factors of symptoms improvement in chronic pancreatitis patients who receive endoscopic therapy. Methods: 772 subjects underwent pancreatic duct stenting at a tertiary care center from 2004 to 2012. Variables collected include ERCP procedure details, etiology, demographics, comorbidities and stent type and size. Logistic regression was conducted to evaluate for predictors. Results: 265 patients (158 males) underwent PD stent placement for chronic pancreatitis from 2004 to 2012. Mean age was 52 years (Range 5 99). Mean number of procedures done was 4.7 (range 1-20). 116 patients had alcoholic pancreatitis (44%), 103 had non alcohol related pancreatic duct strictures (39%), 18 had pancreas divisum (7%), 28 had pancreatic pseudocyst (11%), 19 had Pancreatic duct stones (7%) and 8 had pancreatic duct leak (3%). Pancreatic sphincterotomy was done all patients and all stone patients received ESWL. A total of 82 patients received plastic stents sized larger than 7 French (31%). Improvement in symptoms was achieved in 239 patients (90%). Logistic regression was conducted to evaluate predictive factors for symptom improvement. After adjusting for gender, age, number of procedures, and alcoholic pancreatitis; presence of pancreatic duct stricture with upstream dilation [OR 2.9 (1.05-8.4)] and large stent size (larger than 7 Fr) [OR 3.66 (1.02-13.2)] were associated with improved outcome (as manifested by pain control and improvement in symptoms). Conclusion: Patients with pancreatic stricture and who received larger diameter PD stent placement were more likely to have improvement in symptoms after ERCP. Outcome-based prospective studies are needed to further evaluate predictive factors for therapeutic ERCP in chronic pancreatitis patients. Su1714 A Normal Pancreatogram At Index ERCP Is Associated With Late Minor Papillary Stenosis After Endoscopic Minor Papillotomy in the Setting of Pancreas Divisum Jeffrey J. Easler*, Vladimir M. Kushnir, Daniel Mullady, Dayna S. Early, Steven a. Edmundowicz, Faris Murad Division of Gastroenterology and Hepatology, Washinton University School of Medicine, St. Louis, MO, MO Background: Pancreas divisum (PDv) is an anatomic variant found in 5-10% of the population and associated with idiopathic recurrent acute (RAP) and chronic pancreatitis (CP). Endoscopic minor papillotomy (EMP) has long term efficacy in small prospective trials, particularly in patients with RAP. Stenosis of the minor papilla/dorsal pancreatic duct near the minor papilla (MPS) is a late complication of EMP reported in 11-20% of patients. MPS is often managed by repeat EMP, though efficacy of repeat intervention remains uncertain. To our knowledge no literature exists regarding possible risks of MPS as it relates to initial presentation for index ERCP with EMP. Aims:1) Describe incidence of MPS in the setting of PDv. 2) Identify clinical, diagnostic and therapeutic risk factors prior to and accrued during index intervention for PDv that predict MPS. Methods: Consecutive patients with PDv underwent ERCP between 9/2003 and 7/2013 . Patients with complete PDv managed with therapeutic ERCP of the dorsal pancreatic duct (DPD) were included. Exclusion criteria: failure to access DPD, lack of records, incomplete divisum, and pancreatic malignancy. Records were retrospectively reviewed for clinical data, ERCP findings and outcomes. Pancreatogram findings were categorized by Cambridge Classification*. Late repeat ERCP (lrERCP) was defined as a return for intervention(s) O6 months from index ERCP series. MPS was defined by the endoscopist at lrERCP. Logistic regression was used to evaluate relationships between categorized index ERCP data and MPS. Results:100 consecutive patients (Median Age 49, Female 65%) presented for ERCP for PDv (RAP 59%). MES was performed at index ERCP in 99% of patients with DPD Stent (96%). 55% of patients had Cambridge Classification for a normal index pancreaticogram (Table 1). Post-ERCP pancreatitis (PEP) occurred in 18% of patients. 62% had clinical and/or imaging follow up after index ERCP series in our system O6 months (median 1.2 yrs). Twenty seven % of patients returned for lrERCP (34 months, median) most often for RAP (44%). MPS was identified in 59% and managed with repeat EMP (75%). These patients most often presented with RAP and pain (93.8%). On univariate regression analysis, the absence of Cambridge class DPD changes at index ERCP was associated with development of MPS. (Table 2) Multivariate analysis model including age, sex, failed 1st ERCP, PEP, EMPO5mm and Cambridge classification demonstrated a significant association between a normal index pancreatogram and late MPS (OR 15.2, pZ.05). Discussion: We report 60% incidence of MPS at lrERCP. An association between a normal index pancreatogram and late MPS after EMP was identified. MPS did not correlate with technical aspects www.giejournal.org Vol of or immediate complications after index EMP. MPS represents a frequent finding on lrERCP in patients with recurrent symptoms in setting of PDv. Table 1. Patient Characteristics and Index ERCP in Patients with Symptomatic Pancreas Divisum