• Marco Bassam Mahdi
5. Term (Master thesis), Medicine, Master (Master Programme)
Background and Aim: The clinical course and prognosis of medically managed patients with small duct and large duct chronic pancreatitis (CP) has been scarcely investigated. We inves- tigated all-cause mortality and progression of endocrine and exocrine function in a medically managed cohort of patients with small duct CP and compared them to patients with large duct CP.

Methods: This was a retrospective cohort study of 198 consecutive patients with definitive CP according to M-ANNHEIM criteria. Patients were classified as large or small duct cases based on pancreatic duct morphology on cross sectional imaging. We compared all-cause mortality and rates of diabetes and exocrine insufficiency (EPI) between patient subgroups using Kaplan-Meier and multivariate-adjusted Cox Proportional Hazard Models. In a subgroup of patients with follow-up imaging studies, changes in anteroposterior (AP) diameter of the pancreatic head (n=120) and body (n=122) as well as changes in pancreatic duct morphology (n=121) was studied.

Results: The mean age of subjects were 58 ± 12 years and 70% were male. Large duct CP was seen in 75 patients (38%) and small duct CP by 123 patients (62%). The five-year mortality rate was compared between patient subgroups (HR: 1.07; 95% CI 0.56–2.07) as was the rate of new onset diabetes (HR: 1.55; 95% CI 0.77–3.13). In contrast, new onset of EPI was more prevalent in patients with large duct CP (HR: 1.77; 95% CI 1.10–2.86; P=0.019). Large duct CP was also associated with greater loss of pancreatic parenchyma in the head (coefficient -2.9 mm; 95% CI -4.0– -1.6; P<0.001). Seventeen (14%) with follow-up imaging changed their pan- creatic duct morphology at follow-up, with the majority of patients developing large duct dis- ease (82%).
Conclusion: Medically managed patients with large duct CP have an excess risk of EPI and pancreatic atrophy compared to their counterparts with small duct CP.
Publication date5 Jan 2022
Number of pages11
ID: 457976711