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Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

2017; Elsevier BV; Volume: 19; Issue: 11 Linguagem: Inglês

10.1016/j.hpb.2017.07.006

1477-2574

Yama Issa, Hjalmar C. van Santvoort, Paul Fockens, Marc G. Besselink, Thomas L. Bollen, Marco J. Bruno, Marja A. Boermeester, Frank G. Moody, Claude Bertrand, Colin Johnson, Aude van Lander, Ross Carter, John B. Conneely, Frederik Berrevoet, Donzília Sousa Silva, Zong-fang Li, Philippe Lévy, Kofi Oppong, Timothy B. Gardner, C. Mel Wilcox, Jeremy French, Michael L. Steer, Edward L. Bradley, Peter Layer, Bertrand Napoléon, Jorge Antonio Mosquera, Dirk J. Gouma, Roland Andersson, Antonio Manzelli, J.M. Klaase, Massimo Falconi, Enrique de‐Madaria, Riccardo Casadei, Giuseppe Malleo, Raffaele Pezzilli, Ewa Małecka‐Panas, Matthias Löhr, Julia Mayerle, Erik A. Rauws, Martin L. Freeman, Affirul Chairil Ariffin, Bhavin Vasavada, Paul Bo-San Lai, José Luis Beristain-Hernández, Álvarez Juan, Haralds Plaudis, Dionisios Vrochides, Vincenzo Neri, Vimalraj Velayutham, Aleksey Andrianov, Joan Figueras, Kjetil Søreide, А. Е. Щерба, Mahir Gachabayov, Roger G. Keith, Georgios Tsoulfas, Michael Fink, Stefano Crippa, Mehrdad Nikfarjam, Dibyajyoti Bora, Rajendra Desai, Marcello Donati, Jan Jin Bong, Emma Martínez Moneo, Gareth Morris‐Stiff, Ahmet Çöker, Alexandre Prado de Resende, Suryabhan Bhalerao, Sadiq S. Sikora, Dezső Kelemen, László Czakó, H. Ramesh, О. О. Руммо, Aliaksei Fedaruk, А. Е. Щерба, Alexey Hlinnik, Madhusudhan Chinthakindi, Traian Dumitraşcu, V. Egorov, Vincent Bettschart, Michele Molinari, E. Aldana D. Guillermo, Susan L. Orloff, D. Kostov, Laurent Sulpice, Brett Knowles, Yasutoshi Kimura, Gabriele Marangoni, Rajeev Joshi, T Gyökeres, Bedin, Vukojević Vladimir, Arpad Ivanecz, Adelmo Antonucci, J. Omoshoro–Jones, Richard Nakache, Marco Del Chiaro, Marianne Johnstone, Tomoaki Saito, Gianpaolo Balzano, V. Egorov, S. Chooklin, Piero Boraschi, Walter G. Park, Pedro Pereira, Nico Pagano, Pavlos Lykoudis, Lars Ivo Partecke, Aliaksandr Siatkouski, Rosa Jorba, Yasunari Kawabata, Luís Carvalho Lourenço, Carlos Marra-López, Jun Kyu Lee, Nils Habbe, Robert C. Verdonk, Yu. S. Rabotyagova, Rupjyoti Talukdar, Luca Frulloni, Shamil Galeev, Zoltán Berger, Takeo Yasuda, Thilo Hackert, Ziyovuddin Saatov, Dimitri Aristotle Raptis, Jaume Boadas, Francesco Vitali, Lívia Archibugi, Miroslav Ryska, Balázs Tihanyi, Vikesh K. Singh, Atsushi Masamune, Paul Yeaton, Kerrington D. Smith, Shrey Modi, Laura Iris Cosen-Binker, Savio George Barreto, Eugenio Morandi, Sergio Valeri, Cíntia Yoko Morioka, Luis F. Lara, Yoshifumi Takeyama, Frank G. Gress, Young‐Dong Yu, Ezio Gaia, Sorin T. Barbu, Ali Tüzün İnce, Akkraporn Deeprasertvit, Yu‐Ting Chang, Stephen Abiola, Sabite Kaçar, Peter Muscarella, Henri Braat, Samuel Han, Ali A. Aghdassi, Jean‐Louis Frossard, Jill P. Smith, Matthijs P. Schwartz, Hendrik M. van Dullemen, Niels G. Venneman, B.W.M. Spanier, Sjoerd D. Kuiken, Erwin van Geenen, Gregory J. Beilman, Georgios Papachristou, Óscar Chapa Azuela, Peter van der Schaar, Nevin Oruç, Marie-Paule Anten, William H. Nealon, Jesús García-Cano, Manol Jovani, Ziad Melki, Mustafa Mohammed Ahmed Ibrahim, M.U. Awajdarip, Mohammad U. Azam, K. G. Sabu, Igor Ermolaev, Shiran Shetty, Oana Belei, Juris Pokrotnieks, Malgorzata Lazuchiewicz-Kot, Riadh Bouali, Marek Winiarski, Marcus Schmitt, Mihai Rimbaş, Alexander Meining, Erwan Bories, Peter N. Meier, Rainer Schoefl, Ahmed Altonbary, Igor Marsteller, Ingo Wallstabe, Skerdi Prifti, Arnaud Lemmers, Miklós Horváth, Ajay Kumar, Joseph J. Palermo,

Gastrointestinal disorders and treatments

Abstract Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Büchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.