Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3538-3545
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3538
Continuing episodes of pain in recurrent acute pancreatitis: Prospective follow up on a standardised protocol with drugs and pancreatic endotherapy
C Ganesh Pai, M Ganesh Kamath, Mamatha V Shetty, Annamma Kurien
C Ganesh Pai, Mamatha V Shetty, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal 576104, India
M Ganesh Kamath, Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
Annamma Kurien, Department of Pathology, Melaka Manipal Medical College, Manipal University, Manipal 576104, India
Author contributions: Pai CG designed the study; Pai CG, Kamath MG, Shetty MV and Kurien A performed the research; Pai CG and Shetty MV analysed the data; Pai CG, Kamath MG and Shetty MV wrote the paper; Pai CG revised and finalised the manuscript for submission.
Institutional review board statement: The Ethics Committee of Kasturba Hospital, Manipal approved this study.
Informed consent statement: All study participants provided written informed consent prior to enrolment into this study.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available .
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: C Ganesh Pai, MD, DM, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Madhav Nagar, Near Tiger circle, Manipal, Manipal 576104, India.
Telephone: +91-820-2922192 Fax: +91-820-2571934
Received: January 23, 2017
Peer-review started: January 29, 2017
First decision: February 27, 2017
Revised: March 13, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: May 21, 2017

To assess the outcomes of drug therapy (DT) followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis.


DT comprised of pancreatic enzymes and anti-oxidants failing which, endotherapy (ET; pancreatic sphincterotomy and stent placement) was done. The frequency of pain, its visual analogue score (VAS), quality of life (QoL), serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET. Response was defined as at least 50% reduction in the severity of pain to below a score of 5.


Of the thirty nine patients analysed, 21 (53.9%) responded to DT and 18 (46.1%) underwent ET. The VAS for pain (7.0 ± 2.0 vs 1.3 ± 2.5, P < 0.001) and the number of days with pain per month decreased [1.0 (1.0, 2.0) vs 1.0 (0.0, 1.0), P < 0.001], and the QoL scores [55.0 (44.0, 66.0) vs 38.0 (32.00, 51.00), P < 0.01] improved significantly during follow up. Similar significant improvements were seen in patients in the subgroups of DT and ET except for QoL in ET. The serum C-peptide (P = 0.001) and FE (P < 0.001) levels improved significantly in the entire group and in the two subgroups of patients except for the C peptide levels in patients on DT.


A standardised protocol of DT, followed by ET decreased the intensity and frequency of pain in recurrent acute pancreatitis, enhanced QoL and improved pancreatic function.

Keywords: Drug therapy, Endoscopy, Exocrine insufficiency, Pancreatic diabetes, Pancreatic duct stents, Quality of life, Recurrent acute pancreatitis, Surgery

Core tip: This prospective case series provides evidence for the efficacy of a sequential approach to the treatment of patients with recurrent acute pancreatitis in whom painful episodes persisted after initial aetiological work up and appropriate interventions if any, with drugs and endoscopic therapy. Along with improvements in the intensity and average number of days with pain, the protocol also improved the quality of life, C-peptide levels and faecal elastase in these patients. The significance of our results needs to be explored in future studies on the effect of these interventions in preventing the progression of recurrent acute pancreatitis to chronic pancreatitis.