The impact of pancreatic endotherapy on quality of life in chronic pancreatitis

Abstract

Background and aims: Pancreatic endotherapy (PET) offers a treatment option for adverse events of chronic pancreatitis (CP) such as pancreatic duct (PD) strictures, stones, and pseudocysts. Previous studies have primarily focused on how PET affects pain, so the primary aim of this study was to evaluate the effect of PET on quality of life.

Methods: This single-center prospective study assessed quality of life before the initiation of endotherapy using a validated CP-specific quality of life instrument. Quality of life, pain levels, and opiate use were also measured at 1, 3, 6, and 12 months' follow-up. PET modalities included therapeutic PD stent placement, PD stone lithotripsy, endoscopic ultrasound (EUS)-guided pseudocyst drainage, and celiac plexus block (EUS-CPB). A repeated-measures mixed effects model was used to compare pre- and post-PET changes in quality of life at each follow-up point.

Results: A total of 120 subjects with CP (mean age 52.3 years, 58.3% female) were included in this study. PET modalities consisted primarily of therapeutic PD stenting (49.2%), EUS-CPB (32.5%), and PD stone lithotripsy (16.7%). Significant improvements in quality of life scores were seen at 1, 3, 6, and 12 months after PET completion, with the greatest improvement seen at 6 months (mean increase of 15.5 points). Significant improvements in pain levels were seen at 1 and 6 months, but not at 12 months. Decrease in opiate use was seen at all follow-up points.

Conclusions: PET is associated with improvement in quality of life up to 1 year after treatment, but pain improvement was seen only to 6 months, reflecting the complexity of pain management in this difficult patient population. Further studies are needed to predict responders to endotherapy.