Endoscopic management of early-stage chronic pancreatitis based on M-ANNHEIM classification system: a prospective study

Pancreas. 2014 Aug;43(6):829-33. doi: 10.1097/MPA.0000000000000140.

Abstract

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 contrast-enhanced 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pancreatitis, Chronic / classification
  • Pancreatitis, Chronic / pathology*
  • Pancreatitis, Chronic / surgery*
  • Prospective Studies
  • Severity of Illness Index*
  • Treatment Outcome