Surgical management of failed endoscopic treatment of pancreatic disease.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Kimberly A EvansKevin E Behrns

Abstract

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreat...Continue Reading

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Citations

Nov 26, 2009·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Sebron HarrisonJohn Christein
Jun 11, 2010·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Cherif BoutrosN Joseph Espat
Jul 30, 2014·Journal of the American College of Surgeons·Trevan D FischerKevin E Behrns
Mar 11, 2010·The American Journal of Gastroenterology·Zhao-Shen LiLi Wang
Sep 29, 2018·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Brendan M CaseBryan R Foster
Nov 27, 2010·Expert Review of Gastroenterology & Hepatology·C Mel WilcoxJohn Christein

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