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Prospective Study of Surgical Outcome and Differences on Histopathology in Patients With Alcoholic & Non Alcoholic Chronic Pancreatitis
Srinath S. Rathod1, Rajesh Gupta*1, Sunil D. Shenvi1, Deepak K. Bhasin2, Surinder S. Rana2, Mandeep Kang3, Ritambhra Nada4, Naresh Sachdeva5
1Surgical Gastroenterology Division, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2Gastroenterology, PostGraduate Institute of Medical Education and Research, Chandigarh, India; 3Radiology, PostGraduate Institute of Medical Education and Research, Chandigarh, India; 4Histopathology, PostGraduate Institute of Medical Education and Research, Chandigarh, India; 5Endocrinology, PostGraduate Institute of Medical Education and Research, Chandigarh, India
Background:Alcoholic & non-alcoholic chronic pancreatitis appears to be two different diseases with common final outcome of pancreatic exocrine & endocrine failure.Present prospective study was planned to find the differences in both these in relation to postoperative pain relief ,postoperative changes in exocrine & endocrine function,Imaging and histopathology.
Materials and methods:All patients of chronic pancreatitis admitted in Division of Surgical gastroenterology and Dept. Medical Gastroenterology, PGIMERfrom January 2012 to June 2014were included in the study.Informed written consent was taken from all patients .Surgery was offered in patients who continue to suffer from symptoms despite best medical, endoscopic & radiological management
Results: Total of 24 patients were included in the study with 13 patients being alcoholic pancreatitis and 11 patients being non alcoholic pancreatitis.Mean followup was 15 months.All patients with non alcoholic pancreatitis underwent Frey's procedure. Four patients with alcoholic pancreatitis underwent Pylorus preserving pancreaticoduodenectomy due to head mass and rest all underwent Frey's procedure. When we compared impact of surgery on pain relief, patients with nonalcoholic pancreatitis had statistically significant better results compared to alcoholic pancreatitis.Three patients in non alcoholic pancreatitis and 2 patients with alcoholic pancreatitis had complete resolution of diabetes during follow-up.Patients with alcoholic pancreatitis continued to have steatorrhea in follow up period but none of non alcoholic pancreatitis patients had deterioration in exocrine function .When we compared histopathology in both the groups, patients with alcoholic pancreatitis has statistically significant increase in intralobular inflammatory infiltrate & fibrosis,neuritis , nerve hypertrophy and predominant plasma cell infiltration.Patients with non alcoholic pancreatitis had duct centric infiltration with predominant lymphoplasmacytes.
Conclusion:In this prospective study, non-alcoholic CP patients had better outcome after surgery than alcoholic CP in terms of postoperative pain relief, endocrine and exocrine insufficiency.Histopathologically, pancreatic changes in patients with non-alcoholic chronic pancreatitis markedly differ from those with alcoholic chronic pancreatitis.
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