青少年慢性胰腺炎的内镜介入治疗

目的探讨内镜介入治疗青少年慢性胰腺炎的方法和临床疗效。方法以2002年亚太共识报告中提出的共识意见为慢性胰腺炎诊断标准，回顾分析1997年1月到2006年8月间经内镜介入治疗的青少年慢性胰腺炎患者临床资料，内镜治疗方法等，并随访其疗效。结果36例青少年慢性胰腺炎患者，共行ERCP77次，其中1例2次插管失败，1例胰管置入术未成功，2例失访；成功进行内镜介入治疗和随访的32例患者中，内镜治疗后完全缓解和部分缓解者共26例（81．2％），4例最终行手术治疗；ERCP术后并发症发生率为26．7％（20／75），均经短期药物治疗后好转，无出血、穿孔、死亡病例。结论内镜在治疗青少年慢性胰腺炎方面的初步疗效确切，可作为青少年慢性胰腺炎的一线治疗方法。     

疼痛性慢性胰腺炎内镜介入治疗无效因素初探

目的 探索内镜介入治疗疼痛性慢性胰腺炎（CP）无效的风险因素。方法分析随访1997年至2006年仅经内镜治疗且存活的疼痛性慢性胰腺炎资料,根据患者临床特征及相关研究资料选择与治疗无效可能相关的风险因素,利用Cox比例风险模型进行逐步回归分析。结果患者中男114例、女58例,平均39．4岁,148例（86．0％）内镜治疗有效。多因素Cox比例风险模型逐步回归显示,首发年龄（〉36岁）、治疗前轻中度腹痛、内镜治疗后酒精摄入量无明显减少和饮食不节为内镜治疗无效的预后因素,风险比分别为3．5、2．4、1．9和2．8。结论疼痛性慢性胰腺炎内镜介入治疗后应戒酒和低脂规律饮食,首发年龄大、腹痛程度相对较轻的患者尤其应当注意。     

胰管内支架治疗慢性胰腺炎

目的 探讨胰管内支架引流术治疗慢性胰腺炎的临床疗效。方法 对１４例临床及影像学检查确诊的慢性胰腺炎伴胰管狭窄患者在内镜下进行了胰管内支架引流术，并对术后腹痛缓解率、胃纳、脂肪泻、体重变化及并发症发生率作了近期及远期了随访观察。结果 １４例患者均在内镜下内支架一次性置入成功，支架规格为５～１０Ｆ，术后随访２８～５２０ｄ，平均２１０ｄ，１４例患者术后近期（〈３个月）腹痛缓解率为９２．９％（１３／１４）     

青少年慢性胰腺炎的诊断及外科治疗

目的探讨青少年慢性胰腺炎的临床特点、诊断及外科治疗.方法回顾性分析1993年3月～ 2001年3月手术治疗的7例青少年慢性胰腺炎患者的临床资料.结果青少年患者大多存在先天性胰胆管发育异常(胰腺分裂1例,胰胆管合流异常1例,胆总管囊肿2例).主要症状为反复上腹痛.B超、CT、ERCP和超声内镜(EUS)等影像学检查有助于早期诊断,其诊断阳性率分别为57.1%(4/7)、71.4%(5/7)、100%(5/5)和100%(4/4).7例患者均接受了手术治疗,其中行胰头部分切除、胰管空肠侧侧吻合术(Frey's)1例,胰管切开取石、胰管空肠侧侧吻合术3例(其中Partington's术式2例,Puestow's术式1例),Oddi括约肌切开成形术1例,胆总管囊肿切除、肝管空肠Roux-en-Y吻合术 + 保留十二指肠的胰头切除术(DPPHR)2例.术后近期腹痛均缓解.所有患者均获随访,随访时间2 ～ 9年,平均4.7年.1例于术后8个月症状复发,再次手术行胰尾切除,症状缓解.多数患者疗效满意.结论青少年慢性胰腺炎的病因不同于成人慢性胰腺炎,手术时机的掌握和手术方法的选择对患者的生活质量和疾病进程的控制至关重要.     

慢性胰腺炎138例手术疗效的临床观察

目的总结慢性胰腺炎(chronic pancreatitis,CP)的外科治疗经验,提高手术疗效.方法回顾性分析1 992年3月～2002年5月手术治疗的138例慢性胰腺炎患者的临床资料.结果所有患者均接受了手术治疗,无手术死亡.术后发生胰瘘3例,吻合口出血2例,并发症发生率为3.6%.术后97.8%的患者腹痛明显减轻.124例(89.9%)获1～9年随访,平均随访4.9年,13例症状复发,复发率为10.5%.新发糖尿病7例,脂肪泻5例,死亡5例,其中死于CP并发症2例.结论手术可以延缓慢性胰腺炎的自然进程,而适当的术式能改善患者的生活质量.     

胰管内支架治疗慢性胰腺炎18例临床分析

目的　探讨慢性胰腺炎胰管内支架治疗的临床疗效。方法　取沈阳军区总医院 2 0 0 2 - 0 7～ 2 0 0 4 -17经临床、化验及检查明确诊断为慢性胰腺炎的 18例患者 ,分别接受胰管内支架治疗 ,术后观察随访临床症状及化验检查等指标变化情况。结果　所有患者胰管内支架置放成功 ,腹痛症状在术后 1个月内均基本缓解 ,腹痛缓解率 10 0 % ,消瘦、脂肪泻等症状得到改善 ,除 1例因有胰腺外分泌障碍血清淀粉酶下降慢外 ,其他患者血清淀粉酶均于术后 1～ 14d内降至正常 ,1例患者术后第 10天因支架阻塞更换支架。结论　慢性胰腺炎内镜下置放胰管内支架治疗是一种较安全、低创伤、低费用、见效快的首选方法 ,极具临床应用价值。     

青少年慢性胰腺炎的诊断及外科治疗

目的探讨青少年慢性胰腺炎的临床特点、诊断及外科治疗。方法回顾性分析1993年3月～2001年3月手术治疗的7例青少年慢性胰腺炎患者的临床资料。结果青少年患者大多存在先天性胰胆管发育异常(胰腺分裂1例,胰胆管合流异常1例,胆总管囊肿2例)。主要症状为反复上腹痛。B超、CT、ERCP和超声内镜(EUS)等影像学检查有助于早期诊断,其诊断阳性率分别为57．1％(4／7)、71．4％(5／7)、100％(5／5)和100％(4／4)。7例患者均接受了手术治疗,其中行胰头部分切除、胰管空肠侧侧吻合术(Frey's)1例,胰管切开取石、胰管空肠侧侧吻合术3例(其中Partington's术式2例,Puestow's术式1例),Oddi括约肌切开成形术1例,胆总管囊肿切除、肝管空肠Roux-en-Y吻合术 保留十二指肠的胰头切除术(DPPHR)2例。术后近期腹痛均缓解。所有患者均获随访,随访时间2～9年,平均4．7年。1例于术后8个月症状复发,再次手术行胰尾切除,症状缓解。多数患者疗效满意。结论青少年慢性胰腺炎的病因不同于成人慢性胰腺炎,手术时机的掌握和手术方法的选择对患者的生活质量和疾病进程的控制至关重要。     

内镜黏膜下剥离术治疗早期胃癌

目的 探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的有效件及安全性.方法 对20例早期胃癌患者共21处病灶进行ESD治疗,观察治疗的情况及效果.结果 21处病灶一次性整块切除率为95.2%(20/21),组织学治愈性切除率为90.5%(19/21).平均手术时间50.4 min.急性少量出血率4.8%(1/21),术后腹痛发生率为76.2%(16/21),未发生急性大量出血、穿孔、术后延迟出血.2个月时复查胃镜,溃疡愈合率100%.平均随访9.2个月(8～12个月),局部无残留、复发及异时病灶发生.结论 ESD町提高一次性完整切除率和组织学治愈性切除率,是一种治疗早期胃癌的安全有效的方法.     

复发性特发性胰腺炎内镜治疗的临床分析

目的 探讨复发性特发性胰腺炎(RIP)的病因及其内镜治疗的疗效.方法 回顾性分析2005年4月至2011年4月诊断为RIP的58例患者资料.所有患者均行ERCP,术前怀疑Oddi括约肌功能障碍者行Oddi括约肌测压.根据临床表现和ERCP结果判断病因并制订个体化的内镜治疗措施,术后随访观察腹痛及胰腺炎发作情况.结果 58例患者中男性29例,女性29例,胰腺炎发作次数为3 ～ 10余次.病因为胆管微结石29例,Oddi括约肌功能障碍19例(胰腺型16例,混合型3例),胰胆管汇流异常4例,ERCP无明显异常者6例.行单纯胆管括约肌切开33例,胰胆管括约肌共同切开8例,单纯胰管括约肌切开17例,括约肌切开后同时胰管支架置入术24例.58例患者获得随访41例,随访时间3～67个月(平均33个月).随访期间9例(22.0％)患者胰腺炎复发.内镜治疗RIP有效率为78％(32/41).结论 胆管微结石和Oddi括约肌功能障碍是RIP的主要病因,饮酒是其主要诱因.ERCP及其介入治疗疗效确切.     

急性胰腺炎复发诱因及内镜治疗

目的 探讨急性胰腺炎(AP)复发的诱因及其内镜治疗效果.方法 杏阅2002年1月至2008年12月长海医院收治的AP患者.详细记录患者临床资料;是否行内镜逆行胰胆管造影术(ERCP)治疗、治疗方法及并发症.电话随访后根据是否AP复发将患者分为无复发组与复发组.分析两组致病因素及内镜治疗疗效.结果 804患者入组,其中无复发组512例(63.68%),复发组292例(36.32%).无复发组平均年龄52岁,复发组平均年龄44岁,相差显著(P<0.01).201例重症胰腺炎中,无复发组104例(20.31%),复发组97例(33.22%),复发组显著高于无复发组(P<0.01).无复发组并发胰腺假性囊肿46例,复发组44例,两组胰腺假性囊肿发生率差异显著(P<0.05).AP病因为胆源性、高三酰甘油血症是胰腺炎反复发作的危险因素.139例复发性AP患者行ERCP治疗,15例(5.15%)并发ERCP术后胰腺炎,1例(0.34%)出现十二指肠乳头切开后出血.成功随访内镜介入治疗的118例复发性AP患者,内镜治疗总缓解率为78.8%.结论 复发组发病年龄较小,重症急性胰腺炎发生率及胰腺假性囊肿发生率均高,胆源性及高三酰甘油血症为诱发AP复发的危险因素.内镜介入治疗对复发性AP同样有效.     

Long-term outcomes of therapeutic ERCP in pediatric patients with pancreas divisum presenting with acute recurrent or chronic pancreatitis

ObjectivesThe aim of this study was to evaluate the long-term outcomes of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for pediatric patients with pancreas divisum (PD) presenting with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).MethodsBetween May 2008 and August 2017, pediatric patients with PD who received endotherapy at Ruijin Hospital were identified and grouped according to clinical presentation, namely ARP and CP. Primary success was defined as patients’ improvement in symptoms after index ERCPs, without further intervention or any analgesic.ResultsA total of 74 ERCPs were performed in 38 pediatric patients. The frequency of at least 1 genetic mutation identified in patients with ARP and CP was 44.4% and 68.4%, respectively. Patients with CP required more ERCPs than those with ARP (2.4 ± 1.7 vs. 1.1 ± 0.4, P = 0.005). The incidence of post-ERCP complications was 14.9%, including pancreatitis of 13.5% and hemorrhage of 1.4%. During a median follow-up duration of 41 months (range, 12–123 months), the frequency of pancreatitis episodes decreased significantly from 2.31 to 0.45 (P < 0.0001). The 25% recurrence and reintervention rates were estimated at 25 and 48 months, respectively, without significant difference between patients with ARP or CP. There was a nonsignificant trend towards a higher rate of primary success in patients with ARP than those with CP (92.9% vs. 69.6%, P = 0.123). After further endotherapy, 91.3% patients with CP improved clinically.ConclusionsTherapeutic ERCP is an effective and safe intervention for pediatric patients with symptomatic PD. Patients presenting with CP seem to achieve improvement after additional ERCPs.     

Relapses of biliary acute pancreatitis in patients with previous attack of biliary pancreatitis and gallbladder in situ

AIM: To evaluate relapse of acute pancreatitis in patients with biliary pancreatitis in whom coexisting diseases or patient refusal have excluded cholecystectomy. PATIENTS AND METHODS: Forty-seven patients presenting a first episode of biliary acute pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES). RESULTS: ERCP with ES was successful in all but one patient (97.8%) who was then cholecystectomised. Complications related to the endoscopic procedure were reported in five patients (10.6%). During the follow-up period (median time 12 months; range 1-84 months), 10 patients (21%) suffered from biliary complications. Three patients (6.4%), all with lithiasis of the gallbladder, had relapses of acute pancreatitis, two of them within 2 months of the previous episode, and one about a year later after ingestion of a rich meal and alcoholic beverages. The first two were cholecystectomised. Two patients died during the follow-up period from unrelated diseases. CONCLUSIONS: In subjects who are at high risk for anaesthesia, endoscopic procedures may be utilised.     

Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy

BACKGROUND: Currently, cholecystectomy is recommended for patients with gallstone-induced pancreatitis. ERCP with endoscopic sphincterotomy (ES) within 24 to 48 hours is also suggested for the treatment of acute gallstone pancreatitis. The aim of this study was to determine outcome after cholecystectomy versus ES alone in patients with gallstone pancreatitis. METHODS: One hundred seventeen patients with gallstone pancreatitis were included in this prospective observational study. Inclusion criteria were typical abdominal pain; serum amylase level 3 times or greater than normal; and gallbladder stones and a dilated bile duct, with or without stones, by US, CT, or ERCP. RESULTS: Eighty-three patients (Group A) underwent cholecystectomy after initial evaluation including ERCP in 43 (53%) and ERCP with ES in 38 (47%). The remaining 34 (Group B) underwent successful ERCP with ES alone. Mean follow-up was 33 months for Group A and 34 months for Group B. Recurrent gallstone pancreatitis was noted in 2 patients (2.4%) in Group A (bile duct stone in 2, sludge and papillary stenosis in 1), and in 1 patient (2.9%) in Group B. Ten patients in Group B had follow-up US of the gallbladder that showed disappearance of stones in 3. During follow-up, there was no significant difference in the rates of biliary complications (Group A, 3.6% vs. Group B, 11.6%; p = 0.19) or serious complications (pancreatitis, cholecystitis, cholangitis) (Group A, 3.6% vs. Group B, 5.8%). Also, there was no significant difference in procedure-related complications. CONCLUSIONS: Recurrence of pancreatitis after ERCP with ES alone for gallstone pancreatitis is rare. In patients who have undergone ES alone, cholecystectomy should be considered only if there are overt manifestations of gallbladder disease (e.g., biliary pain, cholecystitis, cystic duct obstruction) and not for prevention of recurrent gallstone pancreatitis. Because treatment by ES alone may be associated with a higher risk of biliary complications during follow-up compared with cholecystectomy, these patients may require close surveillance.     

急性胆源性胰腺炎早期内镜治疗价值

目的探讨急性胆源性胰腺炎早期内镜治疗的价值及其安全性。方法选择92例急性胆源性胰腺炎患者早期（72h内）行ERCP及内镜治疗（ERCP组），并与同期保守治疗40例（对照组）进行比较。结果ERCP组全部成功实施十二指肠乳头切开取石，72例胆总管结石者行网篮及气囊取石，所有92例均行鼻胆管引流，重症组10例同时行胰管支架引流。ERCP组平均腹痛消失时间、血清淀粉酶恢复时间、平均住院天数及平均费用均明显低于对照组。ERCP组重症组病死率8．3％，对照组重症组病死率33．3％。结论急性胆源性胰腺炎早期ERCP治疗是安全的，能降低患者的病死率，减少患者住院天数和费用。     

Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: A retrospective multicenter study

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) has been widely used in pediatric patients with cholangiopancreatic diseases.AIM To evaluate the efficacy, safety, and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction(PBM).METHODS A multicenter, retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019. They were divided into four PBM groups based on the fluoroscopy in ERCP. Their clinical characteristics, specific ERCP procedures, adverse events, and long-term follow-up results were retrospectively reviewed.RESULTS Totally, 112 ERCPs were performed on the 75 children with symptomatic PBM.Clinical manifestations included abdominal pain(62/75, 82.7%), vomiting(35/75,46.7%), acholic stool(4/75, 5.3%), fever(3/75, 4.0%), acute pancreatitis(47/75,62.7%), hyperbilirubinemia(13/75, 17.3%), and elevated liver enzymes(22/75,29.3%). ERCP interventions included endoscopic sphincterotomy, endoscopic retrograde biliary or pancreatic drainage, stone extraction, etc. Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis(9/75, 12.0%), gastrointestinal bleeding(1/75, 1.3%), and infection(2/75, 2.7%).During a mean follow-up period of 46 mo(range: 2 to 134 mo), ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis. The overall effective rate of ERCP therapy was 82.4%; seven patients(9.3%) were lost to follow-up, eight(11.8%) re-experienced pancreatitis, and eleven(16.2%)underwent radical surgery, known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy.CONCLUSION ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM, with the characteristics of minor trauma, fewer complications, and repeatability.     

Features that may predict hospital admission following outpatient therapeutic ERCP

BACKGROUND: Some patients are admitted following outpatient therapeutic ERCP because of adverse events. This study aimed to identify factors that may predict such admissions. METHODS: We prospectively studied admissions for post-ERCP adverse events in 415 consecutive patients undergoing outpatient therapeutic ERCP. Potentially relevant predictors of admission were assessed by univariate analysis and in case of significance included in a multivariate analysis. RESULTS: Admission was necessary in 41 patients (9.9%) because of complications and in 63 (15.2%) for observation of adverse events that did not progress to definable complications. Potential predictors of admission were evaluated comparing patients who required more than an overnight admission (n = 63) with those who did not (n = 352). Multivariate analysis identified three factors that were significant: pain during the procedure (odds ratio 3.8: 95% CI [1.8, 7.9]), history of pancreatitis (odds ratio 2.3: 95% CI [1.1, 4.7]) and performance of sphincterotomy (odds ratio 2.2: 95% CI [1.1, 4.3]). The presence of all these features was associated with a 66.7% likelihood of admission, whereas the absence of pain during the procedure, history of pancreatitis and performance of sphincterotomy made admission likely in only 11.0%, 9.8% and 10.7%, respectively, of the cases. CONCLUSIONS: The occurrence of pain during the procedure, a history of pancreatitis and the performance of sphincterotomy were independent predictors of admission following outpatient therapeutic ERCP.     

Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis

Introduction: There is still uncertainty regarding the efficacy and optimal modalities of extracorporeal shock wave lithotripsy (ESWL) in the treatment of chronic pancreatitis. The aims of the present study were to assess the safety and the efficacy of ESWL, either alone or followed by therapeutic endoscopic retrograde cholangiopancreatography (adjuvant ERCP) and to determine predictive factors of efficacy, in a real-life setting.

Patients and methods: This study included all consecutive patients who underwent an ESWL in a single University Hospital between 2001 and 2012. The indication for ESWL was obstructive stone(s) of the main pancreatic duct resulting in either painful chronic pancreatitis or recurrent acute pancreatitis. Success was defined by resolution of pain, no analgesic treatment, no acute pancreatitis and no surgical treatment for chronic pancreatitis 6 months after the ESWL.

Results: One hundred and forty-six patients were studied; 6/146 (4%) had a complication of ESWL. Among the 132 patients in whom follow-up was completed, 91 (69%) had an adjuvant ERCP. After 6 months of follow-up, 100/132 (76%) patients achieved success. In multivariate analysis, the single significant predictive factor of the success of the ESWL treatment was chronic pain (p?=?0.03). Patients who had chronic pain and needed opioid treatment had less chance of success than patients without chronic pain (OR 95%CI 0.31 [0.07–1.14]). We found no difference in the success rates between patients who underwent adjuvant ERCP and those who had ESWL only (p?=?0.93).

Conclusion: This study shows that the ESWL is a safe and effective treatment for patients with chronic pancreatitis and obstructive stones within the main pancreatic duct. Systematic association with therapeutic ERCP appears to provide no additional benefit and is therefore not recommended.     

青少年慢性胰腺炎的内镜诊断与治疗

目的：研究诊断性和治疗性经内镜逆行胰胆管造影术(ERCP)在青少年慢性胰腺炎(CP)诊断及治疗中的价值。方法：回顾分析1997年2月～2002年2月间确诊为青少年CP并行ERCP的13例临床资料。结果：13例中12例存在腹痛症状，10例有“胰腺炎”病史。ERCP见胰管扩张12例，胰管结石7例，胰腺假性囊肿2例，胰腺分裂症3例，胆囊结石l例。内镜下治疗：乳头括约肌切开术7例，胰管取石6例，支架置入5例，胰管狭窄扩张术4例，副乳头切开2例。ERCP后高淀粉酶血症4例，胰腺炎急性发作3例，均为水肿型胰腺炎。经6—68个月随访，ll例未复发，2例复发者经再次ER-CP治疗后腹痛未再出现。结论：ERCP对青少年CP的诊断及治疗有较高的价值。但青少年CP患者ERCP术后具有较高的并发症发生率，对此内镜医师应高度重视。     

Increased severity of complications after therapeutic ERCP in geriatric patients with chronic pancreatitis: An observational study

Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP.The medical records of patients with CP aged over 65 years (group A) were retrospectively collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (group B) were randomly selected into the control group (matching ratio = 1:2). The success rate and the complication rate of therapeutic ERCP in 2 groups were compared. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analyses.A total of 268 ERCPs were performed in 179 patients of group A and 612 ERCPs in 358 patients of group B. The success rate of ERCP in group A was similar to that of group B (92.16% vs 92.32%; P = .936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in group A and B, respectively (P = .436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P = .002). Female gender (odds ratio [OR] = 3.40; P = .046), pancreas divisum (OR = 7.15; P = .049), dorsal pancreatogram (OR = 7.40; P = .010), and lithotripsy (OR = 0.15; P = .016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients.Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.     

Chronic pancreatitis. Long-term pain relief with or without surgery,cancer risk,and mortality

To determine the natural history of chronic pancreatitis (CP), we retrospectively studied 193 consecutive patients who had at least one hospitalization for the control of pain or a complication of CP by examining the hospital records and by using a standard questionnaire. Alcohol (66%) was the major cause of CP and the cause was unknown in 21%. Pain was the presenting symptom in 93%. Pancreatic calcification was observed in 41% (alcoholic 54% vs. nonalcoholic 19%; OR = 6.7, CI = 2.7, 14.3; p < 0.0001). Diabetes (28%), malabsorption (16%), pseudocysts (21%) and pancreatic (3%) or extrapancreatic malignancy (5%) were the main complications. 43% had surgical intervention for pain relief, 10% had either endoscopic sphincterotomy or surgical sphincteroplasty and 16% had surgery for complications. Surgical or endoscopic intervention was more commonly performed in nonalcoholics compared with alcoholics (OR = 12.8, CI = 3.6, 53.9; p < 0.0001). However, if sphincterotomy and sphincteroplasty were excluded, the total number of surgical procedures for pain relief was similar in both groups. Complete follow-up information was available in 107 patients with a mean duration of follow-up of 10 years (range, 1-28 years); 27 patients died during the follow-up; 5, 10 and 15 year mortality was 14%, 18% and 20% respectively. The mortality was significantly higher in patients with alcoholic CP than in nonalcoholic CP (35% vs. 10%; OR = 1.4, 18.7; p = 0.005). Of the 80 patients who were alive and had complete long-term follow-up, pain improved in 62 patients, remained unchanged in 17 and worsened in one. Pain improved in 34 of 41 (83%) patients who had surgical intervention for pain, 7 of 9 patients (78%) who had surgery for complications, 4 of 7 (57%) who had sphincter ablation and 17 of 23 patients (74%) who had nonprocedural treatment. Long-term pain relief was similar in patients with alcoholic and nonalcoholic pancreatitis.