Endotherapy for Painless Chronic Pancreatitis (EACH)
Pancreatitis, Chronic, Exocrine Pancreatic Insufficiency, Abdominal Pain
About this trial
This is an interventional treatment trial for Pancreatitis, Chronic focused on measuring chronic pancreatitis, endoscopic retrograde cholangiopancreatography, Exocrine Pancreatic Insufficiency, painless
Eligibility Criteria
Inclusion Criteria:
- diagnosed with chronic pancreatitis without pain attack related with chronic pancreatitis;
- calcified stone in the cephalic or corporeal portion of the main pancreatic duct with upstream duct dilation;
- no ERCP or ESWL carried out before admission;
Exclusion Criteria:
- suspected to have malignant tumors;
- history of pancreatic surgery or gastrojejunostomy (Billroth II);
- with end-stage disease;
- pregnancy or lactation;
- refuse to write informed consent
Sites / Locations
- Changhai HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Other
Endoscopic group
Conservative group
The patients received intravenous analgesia (flurbiprofen and remifentanil) before the ESWL (Compact Delta II; Dornier Med Tech, Wessling, Germany). After the last ESWL session, the patients are treated with following ERCP within 48h. ERCP was performed under conscious sedation with intramuscular administration of diazepam 2.5-5.0 mg and pethidine 25-50 mg. If necessary, endoscopic sphincterotomy was performed. A dilating bougie or balloon will be used to dilate the stenosis after sphincterotomy. Standard techniques (i.e., extraction basket, extraction balloon, or both) will be used for stone removal. A pancreatic duct stent for drainage and nasopancreatic catheters will be inserted for temporary drainage if necessary. Conservative treatments similar to patients in the control group were given in endoscopic group according to patients' condition.
Patients will have pancreatic enzymes (Pancreatin Enteric-coated Capsules or Oryz-Aspergillus Enzyme and Pancreatin Table) to control symptoms of exocrine pancreatic insufficiency. The recommended initial dose for adults is (25 000-40 000) IU lipase per meal (40 000 IU for meals and 20 000 IU for snacks), which can be increased until the PEI is relieved. The maximum recommended dose is (75 000-80 000) IU lipase per meal. Actions including drugs(Acarbose Tablets, Glucophage, Glimepirde Tablets) or insulin(Biosynthetic Human Insulin Injection, Tresiba or both) would also be taken for control of diabetes according to patients' glucose levels.