Efficacy of endoscopic pancreatic sphincterotomy: A long-term follow up study

Endoscopic pancreatic sphincterotomy (EPS) has been touted as effective therapy for several disorders including chronic pancreatitis and unexplained abdominal pain associated with pancreatic sphincter dysfunction. Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months after EPS. Methods: We reviewed the data on all patients who had EPS performed at our institution over a 4 year period between August 1992 and November 1996. Patients were then contacted by a physician other than the original endoscopist and asked to rate their pain before EPS and at follow-up. A linear pain scale score (0-10 where 10 is the worse possible pain) was used for this purpose with clinical improvement defined as a >50% reduction in the pain score Results: The data on 55 patients were available for review. There were 17 males and 38 females (mean age 43.6 ± 16.7 years). Indications for EPS included 1) chronic pancreatitis [n=40] 2) unexplained abdominal pain with pancreatic sphincter dysfunction (pSOD) [n=15]. EPS was associated with pancreatitis in 5 patients (9%), bleeding in 2 (3.6%) and early stent occlusion in 5 (9%). 7 patients had surgical sphincteroplasty after EPS. No patient died from EPS. After a median follow-up of 16 months (the longest being 52 months) 60% of all patients were improved, with an overall improvement in pain scores (3.6 ± 3.4 vs. 8.8 ± 1.8 pre-EPS; P< 0.0001). The response rate was even more impressive in the pSOD group with 73% of the patients reporting improvement and a reduction in mean pain scores from 9.0 ± 1.6 to 2.9 ± 3.3 after sphincter ablation (P < 0.001). Conclusions: In a subgroup of patients with pancreatic disease and pancreatic sphincter dysfunction, EPS results in significant clinical improvement that may be sustained for several years.