| Basic characteristics and long-term follow-up study on endoscopicmanagement of painless chronic pancreatitis:A retrospective studyObjective: Chronic pancreatitis(CP)is a disease of the pancreas characterized by progressive fibrosis of pancreas caused by genetic and environmental.Pain is one of the most common manifestations of chronic pancreatitis(CP).However,there also existed another form of CP with insidious onset,called painless CP,who never report pain during clinical course and diagnosed due to check-up or symptoms of diabetes mellitus(DM)or steatorrhea indicating pancreatic endocrine and exocrine insufficiency.Physicians generally pay more attention to the patients with chronic pain in the process of diagnosis and treatment of patients with chronic pancreatitis and research concerning with clinical features of painless CP is limited,and there were no relevant clinical studies describing long-erm outcome of endoscopic treatment for painless CP patients.In this study,we constructed a clinical cohort of patients with painless CP and analyzed their baseline data,long-term outcome of endoscopic treatment and influencing factors in order to better understand the clinical characteristics of painless CP patients and provide reference for optimizing the management of painless CP patients.Methods: This cohort retrospectively enrolled patients with a diagnosis of painless CP who were admitted to our gastroenterology department receiving endoscopic treatment and/or extracorporeal shock wave lithotripsy(ESWL)between January 2008 and October 2020.Detailed demographic data(including age,gender,weight,history of smoking,history of alcohol consumption,etc.)and CP-related medical history information(including symptoms leading to diagnosis,digestive symptoms,endocrine and exocrine function,pancreatic stone,etc.)were collected and statistically analyzed.The last follow-up time was April 2022 and information including improvement of digestive symptoms,endocrine and exocrine function,weight,medication was recorded.Results:(1)209 patients were included after excluding 64 patients who lost to followup,with median age at treatment of 54.0(44.0–61.0)years old,including 132(63.2%)males.The median body mass index(BMI)was 22.0(19.7-23.7)kg/m2.The median follow-up time was 47 months,ranging from 20 to 166 months.The most common reason for diagnosis was check-up in 154(73.7%)patients,followed by pancreatic insufficiency in 38(18.2%)patients.89(42.6%)patients had a smoking history and 105(50.2%)patients had a drinking history.(2)DM and steatorrhea were present in 105(50.2%)and 69(33.0%)patients before endoscopic treatment,respectively.A total of 51 patients were classified as chronic pancreatitis-related type 3c diabetes mellitus(CP-T3 c DM)among DM patients.Patients with DM before endoscopic treatment had higher age of diagnosis(54.0 vs 50.0 years old,P=0.020)and treatment(54.6 vs 50.8 years old,P=0.025)compared with those without DM.Patients with steatorrhea before endoscopic treatment had lower BMI(20.7 vs 21.9 kg/m2,P=0.020)and more patients had decreased weight(59.4% vs 39.3%,P=0.006)before treatment compared with those without steatorrhea.(3)Glycated hemoglobin A1c(Hb A1c)before and after endoscopic treatment were(7.1±1.8)% and(6.7±1.3)%,which was significantly decreased(P=0.002).The median weight before and after endoscopic treatment were 60.0(53.9-67.8)and 60.0(55.0-70.0)kilogram,without no significant difference(P=0.244).Complete relief of steatorrhea was found in 25(36.2%)of 69 patients who report steatorrhea before endoscopic treatment while 2(2.9%)reported deterioration.The univariate results showed that sex,smoking,and drinking history were associated with the relief of steatorrhea,and multivariate regression analysis suggested that male(OR=0.17;95%CI,0.34-0.88;P = 0.034)was an independent prognostic factor.Conclusion: In this study,clinical features and long-term outcome were analyzed and we found that painless CP had better glucose control and achieved relief of steatorrhea after endoscopic treatment,especially in those female patients.The efficacy of endoscopic management on pancreatic endocrine andexocrine function for painless chronic pancreatitis: a prospective studyObjective: Painless CP is characterized by the absence of pain and usually diagnosed due to check-up or symptoms of pancreatic endocrine and exocrine insufficiency.Endoscopic treatment was considered as the first-line treatment for CP patients,but the necessity of endoscopic treatment for painless CP patients remains controversial.There is no study relevant with the improvement of pancreatic function after endoscopic treatment for painless CP patients.In this study,we constructed a prospective clinical cohort of patients with painless CP and analyzed their baseline data and improvement of pancreatic function in order to determine whether painless CP can benefit from endoscopic treatment.Methods: This cohort prospectively enrolled patients with a diagnosis of painless CP who were admitted to our gastroenterology department receiving endoscopic treatment and/or extracorporeal shock wave lithotripsy(ESWL).Detailed demographic data(including age,gender,weight,history of smoking,history of alcohol consumption,etc.),CP-related medical history information(including symptoms leading to diagnosis,digestive symptoms,endocrine and exocrine function,pancreatic stone,etc.),endoscopic treatment information(including times of ESWL,removal of stones,endoscopic stenting,etc.),pancreatic endocrine and exocrine function indicators(including fasting C-peptide,fasting insulin,fecal elastase-1[FE-1],etc.)were collected and statistically analyzed.Pancreatic endocrine and exocrine function indices,Hb A1 c and weight were recorded when patients were followed up for one year after endoscopic treatment.Results:(1)133 patients were enrolled in this prospective study between December2020 and December 2022,including 88(66.2%)males.The median age at diagnosis and treatment was 49.0(37.0-56.0)years old and 50.0(38.0-57.0)years old.The mean weight was(60.2±11.0)kilogram.The most common reason leading to diagnosis of painless CP was check-up(48.1%),followed by steatorrhea in 19(14.3%)patients and diabetes mellitus(DM)in 13(9.8%)patients.36(27.1%)patients had a smoking history,and 103(77.4%)patients had a drinking history.107 patients(80.5%)were idiopathic chronic pancreatitis(ICP)and 13 patients(9.8%)were alcoholic chronic pancreatitis(ACP).(2)DM and steatorrhea were present in 61(45.9%)patients and 45(33.8%)patients before endoscopic treatment,respectively.Fasting c-peptide was lower than normal reference range in50(37.6%)patients and pancreatic exocrine insufficiency(PEI)defined as FE-1 levels<200ug/g was present in 100(75.2%)patients.The median Hb A1 c,fasting c-peptide and FE-1were 6.2(5.6-7.3)%,1.2(0.7-1.6)ng/ml and 16.4(15.0-198.9)ug/g,respectively.(3)Larger stone(OR=2.15;95%CI;1.02-4.54;P=0.045),PEI(OR=3.61;95%CI 1.30-9.99;P=0.014)and BMI<20kg/m2(OR=2.51;95%CI 1.04-6.05;P=0.041)were independent risk factors for fasting c-peptide lower than normal reference range before endoscopic treatment in multivariate regression analysis.Smoking(OR=6.57;95%CI 1.27-34.12;P=0.025)was independent risk factors for PEI before endoscopic treatment in multivariate regression analysis.(4)Hb A1 c,fasting c-peptide,fasting insulin,FE-1,weight,BMI were not significantly different before and after endoscopic treatment(P>0.05).However,Hb A1 c was lower(7.5 vs 7.1%,P<0.001)and fasting c-peptide(0.9 vs 1.1ng/ml,P=0.031)was higher for painless CP patients with DM after endoscopic treatment.Conclusion: Smoking is a risk factor for PEI,and larger stone,PEI and BMI<20kg/m2 are risk factors for fasting c-peptide lower than normal reference range before endoscopic treatment in painless CP patients.Pancreatic function is not improved after endoscopic treatment in painless CP patients,with pancreatic endocrine function improved and glycemic management better controlled in painless CP patients with DM. |
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