Pain Relief

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Many more patients with chronic pancreatitis can safely turn to a minimally invasive operation for long-term pain relief, according to a new study by Johns Hopkins physicians.

Endoscopic therapy is an effective alternative to more invasive surgery or drugs, says Anthony N. Kalloo, M.D., director of gastrointestinal endoscopy at Hopkins and lead author of the study that appears in the July issue of Gastrointestinal Endoscopy.

"Doctors have been trained to avoid endoscopic interventions on the pancreas because of the fear of significant complications," says Kalloo. "But we found that patients in our study had few complications, needed less pain medication and improved their quality of life."

Chronic pancreatitis, long-term inflammation of the pancreas, affects up to 5 percent of the United States population. Caused by various factors including alcoholism, the disease creates severe and even crippling upper-abdominal and back pain.

In many cases, Kalloo says, pain may be caused by elevated pressures in the pancreatic duct. For these patients, endoscopic therapy that includes endoscopic pancreatic sphincterotomy (EPS), in which surgeons cut the sphincter muscle at the end of the pancreatic duct to release pressure, has proven effective in the short term, but the Hopkins study was designed to assess its long-term value.

Kalloo and his team reviewed data from 55 patients who underwent EPS for chronic pancreatitis or an ailing pancreatic sphincter at Johns Hopkins between August 1992 and November 1996.

Doctors included in the study all patients who could be contacted by phone for interviews, with an average follow-up time of 16 months after surgery. Interviewers asked patients to recall their level of pain before the procedure and at the time of the interview.

The doctors discovered that 62 percent of the patients reported significant improvement in their pain, with significant improvement defined as a greater than 50 percent decrease in pain score.

"Many patients with chronic pancreatitis have not looked beyond taking pain medication because they fear the invasive nature of surgery," says Kalloo. "The EPS approach offers another option that is less invasive than surgery and has a potential to offer long-term relief."

Other authors of the study include Patrick I. Okolo, M.D., from Northwestern University and Pankaj J. Pasricha, M.D., from the University of Texas Medical Branch.

Currently, Kalloo is enrolling people with chronic pancreatitis for a second prospective study of EPS at Hopkins. For information about the new clinical trial, please call 410-955-9697.

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