A common surgery done to prevent pancreatitis does not actually work, a new study has found.
About one in 10 people are born with a condition called pancreas divisum, in which pancreas ducts fail to fuse properly. While often asymptomatic, it can sometimes be a factor in recurrent pancreatitis, a serious and painful condition.
Retrospective studies have suggested that a minimally invasive surgery called endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) eases acute pancreatitis in 50% to 70% of such patients.
However, ERCP itself can cause acute pancreatitis in 10%-20% of patients and may instigate other issues later, such as scarring of the pancreas opening, which may lead to other symptoms, study leader Dr. Gregory Cote of Oregon Health & Science University said in a statement.
Despite the known risks of the procedure, until now there have been no trials comparing miES to a sham procedure.
At the Digestive Disease Week meeting, his team reported on 148 patients with pancreas divisum and an average of three previous episodes of pancreatitis who were randomly assigned to undergo miES or a sham procedure.
During a median follow-up of 33.5 months, there was no statistically significant difference in the number of patients who had another bout of acute pancreatitis. There were also no differences in numbers of patients who reported pancreas-related pain more than a month after the procedure or who developed chronic pancreatitis, diabetes, or inadequate production of digestive enzymes by the pancreas.
The findings are “actually quite extraordinary when you consider that many doctors have advocated for this procedure for decades,” Cote said.
“Guidelines currently recommend/acknowledge pancreas divisum as a risk factor for pancreatitis, and suggest ERCP as a treatment. These guidelines are likely to change based on this study,” he said.
He added that some patients with conditions such as a narrowing or blockages of the pancreatic duct might still benefit from ERCP. Patients with those conditions were not included in this study.