DDSEP Quick Quiz

DDSEP® 8 Quick Quiz - March 2018 Question 2

A 68-year-old woman with alcoholic chronic pancreatitis has constant, disabling pain. She has previously tried gabapentin, celecoxib, and antioxidants with partial improvement. She currently takes nonenteric coated pancrealipase (90,000 IU per meal) and controlled-release oxycontin. CT of the abdomen demonstrates a few small punctate calcifications in the head of the pancreas, a 1-cm calculus in the genu with a markedly dilated pancreatic duct in the body and tail, and moderate distal atrophy. There are no pseudocysts. She discusses further options to treat her pain.

Which intervention will most likely improve her pain and quality of life over the next 5 years?

DDSEP® 8 Quick Quiz - March 2018 Question 2

A. Continued medical therapy and increased dose of pancreatic enzymes

B. Lateral pancreaticojejunostomy (Peustow procedure)

C. ERCP with lithotripsy and stent placement

D. EUS-guided celiac plexus block

E. Total pancreatectomy with islet autotransplantation

Correct Answer: B

The patient has a favorable anatomy for a surgical drainage procedure such as a lateral pancreaticojejunostomy (Peustow procedure). Surgery has been noted to provide superior pain relief over 5 years compared with endoscopy. Hospital costs and length of stay were similar between the groups. Continued medical therapy is unlikely to add further benefit on top of what she has already achieved. EUS-guided celiac plexus block will only provide temporary pain relief. There are limited long-term data on the effectiveness of total pancreatectomy with islet autotransplantation in alleviating pain.

1. Cahen D.L., Gouma D.J., Laramée P., et al. Gastroenterology. 2011;141(5):1690-5.
2. Conwell D.L., Lee L.S., Yadav D., et al. American pancreatic association practice guidelines in chronic pancreatitis. Pancreas. 2014;43:1143-62.

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