Evaluation of the Manchester classification system for chronic pancreatitis

Abstract

Context: Classifications of chronic pancreatitis based on either histologic (Marseilles) or endoscopic (Cambridge) criteria are not widely used.

Objective: The present study describes the development and validation of a three-stage clinical categorical classification system for chronic pancreatitis.

Design: Patients with a diagnosis of chronic pancreatitis (577.1: ICD-9) for 1993 were identified from records of the Hepatopancreaticobiliary service at a University hospital. Endoscopic or CT evidence of chronic pancreatitis were mandatory for inclusion.

Patients: Forty one patients met the criteria and were categorized according to a 3-stage system as mild, moderate or end-stage disease.

Main outcome measure: The clinical course over the subsequent decade was followed by chart review with re-categorization of stage at each review.

Results: At the outset of the study, 18 (44%) patients were categorised as having mild disease, 19 (46%) as moderate and 4 (10%) as end-stage. The number of patients with mild disease fell over the subsequent 5 years and at the end of the 10-year chart study period, no patients were categorised as mild. The number of patients with diabetes at the outset of the study period was 2 (5%). At two years this was 3 (7%), five years 10 (24%) and 10 years was 25 (61%).

Conclusions: These results show that the Manchester classification of chronic pancreatitis is both practical and feasible and now requires prospective evaluation and independent appraisal by other centres.