BACKGROUND
Studies reporting on pancreatic function after endoscopic treatment of chronic pancreatitis are scarce. This study was aimed at prospectively investigating the evolution of pancreatic endocrine and exocrine function in patients who underwent endoscopic treatment using endocrine function parameters and fecal tests for exocrine function.
METHODS
Between September 2015 and December 2016, patients requiring endoscopic drainage for chronic pancreatitis with ductal obstruction were enrolled in the study and were subjected to prospective evaluation of their endocrine and exocrine function. Endocrine function was assessed by HbA1c, fasting blood insulin level, C-peptide level, and HOMA test before endoscopic treatment and at 1, 3, 6, and 9 months following intervention. Exocrine function was assessed by 72h fecal fat test, fecal acid steatocrit, and fecal elastase level. A comparative analysis was performed between the different post-intervention measurements (at 1, 3, 6, and 9 months) and baseline values.
RESULTS
In total, 34 patients (age: 54+12 years, 67.6% of males) were included. Statistically significant improvement in HbA1c was observed at 1 (6.6 vs. 6.2, p=0.001), 3 (6.6 vs. 6.1, p=0.005), and 9 months (6.6 vs. 6.0, p=0.006) as compared to baseline values. HOMA-B values were statistically higher at 1 (53.0 vs. 67.2, p=0.002), 3 (53.0 vs. 68.6, p=0.001), 6 (53.0 vs. 75.4, p<0.001), and 9 months (53.0 vs. 75.0, p<0.001). Clinical success of endoscopic drainage, defined as a 50% reduction in visual analog scale (VAS) score as compared to baseline, was documented in 72, 84, 80, and 77% of patients at 1, 3, 6, and 9 months, respectively. Exocrine function was not assessable due to patients’ poor compliance to stool sampling.
DISCUSSION
To our knowledge, our study was the first to prospectively evaluate the effect of endoscopic treatment on the pancreatic endocrine function as the primary endpoint. Our study revealed significant improvements in endocrine function at 1, 3, 6, and 9 months following endoscopic drainage. In all patients included, all endocrine function variables (HbA1C, fasting plasma glucose, fasting blood insulin, C-peptide, HOMA-B) improved at each measurement time point. Similar results were obtained in diabetic patients under insulin therapy or oral antidiabetic medications, as well as in non-diabetic patients.
CONCLUSION
Endoscopic therapy in chronic pancreatitis improves glycemic control and pancreatic endocrine function in the short-and mid-term follow-up.