ORIGINAL ARTICLE
Endoscopic Management of Early-Stage Chronic Pancreatitis Based on M-ANNHEIM Classification System A Prospective Study Yuan-Xiang He, MD,*Þ Hong-Wei Xu, MD,*þ Xiao-Tian Sun, MD,* Zhou Ye, MD,*§ Wei Wang, MD,* Xiao-Wei Lai, MD,* Xin-Tao Wang, MD,* Liang-Hao Hu, MD,* Chang Sun, MD,* Zhuan Liao, MD,* and Zhao-Shen Li, MD*
Objective: The aim of this study was to evaluate the M-ANNHEIM classification system to categorize patients with chronic pancreatitis (CP). Methods: All symptomatic patients recruited from the gastroenterology outpatient clinic of Changhai Hospital (n = 89) were routinely evaluated by magnetic resonance cholangiopancreatography and contrastenhanced computed tomography. M-ANNHEIM clinical staging was used to categorize patients. The primary outcome measure was pain during the 2-year follow-up period, expressed as mean Izbicki pain scores obtained before and after endotherapy. Results: There was a significant improvement in mean (SD) Izbicki pain scores obtained at 24 months among patients receiving endoscopic therapy at stage 1a compared with those at stage 1b (4.9 [3.0] vs 14.5 [6.9], P = 0.012). Furthermore, significantly more patients receiving endoscopic therapy at stage 1a achieved complete + partial pain relief after 2-year follow-up than those at stage 1b (95.2% vs 78.0%, P = 0.021). There was no exocrine or endocrine insufficiency, but a significantly greater number of patients treated at stage 1a had post-endoscopic retrograde cholangiopancreatography pancreatitis compared with those at stage 1b (10.5% vs 2.7%, P = 0.025). Conclusions: We demonstrated that a sophisticated M-ANNHEIM classification system for CP will improve diagnosis by allowing for more timely intervention. Furthermore, prompt treatment of CP may achieve improved pain relief and patient outcomes. Key Words: chronic pancreatitis, endotherapy, M-ANNHEIM classification, follow-up (Pancreas 2014;43: 829Y833)
C
hronic pancreatitis is an inflammatory process that leads to the progressive and irreversible destruction and substitution
From the *Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; †Department of Surgical Oncology, General Hospital of Chinese People’s Liberation Army, Beijing, China; ‡Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China; and §Department of Gastroenterology, Fuzhou General Hospital, Fuzhou, China. Received for publication August 16, 2013; accepted March 4, 2014. Reprints: Zhuan Liao, MD, Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 168 Changhai Road, Shanghai 200433, China (e
Endoscopic Management of Early-Stage Chronic Pancreatitis Based on M-ANNHEIM Classification System A Prospective Study Yuan-Xiang He, MD,*Þ Hong-Wei Xu, MD,*þ Xiao-Tian Sun, MD,* Zhou Ye, MD,*§ Wei Wang, MD,* Xiao-Wei Lai, MD,* Xin-Tao Wang, MD,* Liang-Hao Hu, MD,* Chang Sun, MD,* Zhuan Liao, MD,* and Zhao-Shen Li, MD*
Objective: The aim of this study was to evaluate the M-ANNHEIM classification system to categorize patients with chronic pancreatitis (CP). Methods: All symptomatic patients recruited from the gastroenterology outpatient clinic of Changhai Hospital (n = 89) were routinely evaluated by magnetic resonance cholangiopancreatography and contrastenhanced computed tomography. M-ANNHEIM clinical staging was used to categorize patients. The primary outcome measure was pain during the 2-year follow-up period, expressed as mean Izbicki pain scores obtained before and after endotherapy. Results: There was a significant improvement in mean (SD) Izbicki pain scores obtained at 24 months among patients receiving endoscopic therapy at stage 1a compared with those at stage 1b (4.9 [3.0] vs 14.5 [6.9], P = 0.012). Furthermore, significantly more patients receiving endoscopic therapy at stage 1a achieved complete + partial pain relief after 2-year follow-up than those at stage 1b (95.2% vs 78.0%, P = 0.021). There was no exocrine or endocrine insufficiency, but a significantly greater number of patients treated at stage 1a had post-endoscopic retrograde cholangiopancreatography pancreatitis compared with those at stage 1b (10.5% vs 2.7%, P = 0.025). Conclusions: We demonstrated that a sophisticated M-ANNHEIM classification system for CP will improve diagnosis by allowing for more timely intervention. Furthermore, prompt treatment of CP may achieve improved pain relief and patient outcomes. Key Words: chronic pancreatitis, endotherapy, M-ANNHEIM classification, follow-up (Pancreas 2014;43: 829Y833)
C
hronic pancreatitis is an inflammatory process that leads to the progressive and irreversible destruction and substitution
From the *Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; †Department of Surgical Oncology, General Hospital of Chinese People’s Liberation Army, Beijing, China; ‡Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China; and §Department of Gastroenterology, Fuzhou General Hospital, Fuzhou, China. Received for publication August 16, 2013; accepted March 4, 2014. Reprints: Zhuan Liao, MD, Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 168 Changhai Road, Shanghai 200433, China (e
