Outcomes after treatment for patients with idiopathic acute pancreatitis

No cause is found at routine evaluation in up to 40% of patients with recurrent acute pancreatitis. Very little has been reported regarding outcomes after therapy in these patients. Purpose: To assess outcomes of endoscopic treatment in patients referred for ERCP with a diagnosis of idiopathic acute pancreatitis (IAP). Methods: 67 consecutive patients with IAP had ERCP with endoscopic therapy and at least 6mo follow-up. Patients were surveyed (mail or phone) regarding their global condition (excellent, good, fair, poor, terrible), severity (0=no pain to 10=unbearable) of attacks, and number of medical encounters for 6mo periods before and after therapy. Patients were also asked to assess (5 point Likert scale) the change in their overall condition (much improved to much worse) and satisfaction with care (very satisfied to very dissatisfied). Complications after therapy were graded (Gastrointest Endosc. 1991;37:383-393). Results: Forty-six patients (69%) have completed the survey to date. Ten patients had one attack and 36 had recurrent attacks of IAP. There were 39 females and 7 males with a mean age of 57 yrs (range 23-84). Therapy for sphincter of Oddi dysfunction (n=23), pancreas divisum (n=12), biliary (n=5), and other (n=6) included: biliary sphincterotomy (sphx) in 24(52%); biliary and pancreatic sphx in 7(15%); minor papilla therapy in 14(31%); and pancreatic sphx in 1(2%). 6mo Before Treatment 6mo After Treatment Global Condition fair to terrible 89% fair to terrible 4% good to excellent 11% good to excellent 96% Severity of Attacks x̄ 8.5(±2.4 SD) 1.7 (± 2.6 SD) Hospitalizations (≥1) 89% 23% Twenty-nine (63%) described the change in their overall condition as "much improved", 14(30%) considered their condition "somewhat improved", and 3(7%) were "unsure". Forty-one (89%) reported they were "very satisfied" with their care, while 5(11%) were "somewhat satisfied". Six (13%) had immediate post-ERCP pancreatitis (4-mild; 1-moderate; 1-severe); there were no other complications. Conclusions: At six month follow-up, endoscopic treatment for idiopathic acute pancreatitis reduces the severity of attacks and hospitalizations. The majority of patients considered their overall condition to be improved after endoscopic therapy and were satisfied with their care.