Harindranath Sidharth, Patra Biswa R, Ansari Abu A, Vaidya Arun, Singh Ankita, Sundaram Sridhar, Phadke Aniruddha, Shukla Akash
Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND.
Cureus. 2024 Aug 7;16(8):e66378. doi: 10.7759/cureus.66378. eCollection 2024 Aug.
Background and aim Pancreatic endotherapy has been established as a viable and effective modality for the management of pain in chronic pancreatitis (CP). However, its impact on endocrine insufficiency has been rarely reported. In this retrospective study, we aimed to assess the impact of endotherapy on glycemic status and the management of diabetes in these patients. Methods A retrospective review of a prospectively maintained database of patients with CP with pain presenting to the King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India, from December 2021 to May 2023 was done. Detailed clinical, laboratory, imaging, and treatment data were recorded. Endocrine dysfunction was defined as glycosylated hemoglobin (Hba1C) ≥6.5 g/dl. The status of endocrine function (Hba1C values) before and after endotherapy, as well as the requirement of oral hypoglycemic agent (OHA) and/or insulin, was recorded. Results One hundred forty-one patients underwent endoscopic retrograde cholangiopancreatography for the management of pain (mean age: 35 years, 74.5% males). Prior to endotherapy, pathological endocrine dysfunction was seen in 60 patients (42.5%). The mean HbA1c value was 8.46 g/dl (4.5-16.1g/dl). OHAs alone were used in 13/60 (21.6%), and 34/60 (56.6%) required insulin. A combination of OHA and insulin was required in 13/60 (21.6%) of patients. Post-endotherapy, none of the patients were on a combination of OHAs and insulin; 5/13 (38.4%) patients were on OHAs alone, while 8/13 (61.5%) patients were shifted to insulin. Out of the total 47 patients who required insulin, insulin could be stopped in 15/47 (31.9%) of patients. Patients who demonstrated improvement in endocrine dysfunction had significantly lower HbA1c values (6.38 vs. 8.07 g/dl, p < 0.001), a higher proportion of patients with idiopathic pancreatitis (73.3% vs. 22.2%, p = 0.004), and a lower proportion of patients with concomitant exocrine insufficiency (13.3% vs. 53.3%, p = 0.007). Conclusions One-third of the patients had improvements in endocrine dysfunction. Early ductal intervention in a selected subset of patients with CP may have the potential to improve glycemic status.
背景与目的 胰腺内治疗已被确立为一种治疗慢性胰腺炎（CP）疼痛的可行且有效的方式。然而，其对内分泌功能不全的影响鲜有报道。在这项回顾性研究中，我们旨在评估内治疗对这些患者血糖状态及糖尿病管理的影响。
方法 对2021年12月至2023年5月期间就诊于印度孟买爱德华国王纪念医院和塞思·戈尔丹达斯·孙德达斯医学院的CP伴疼痛患者的前瞻性维护数据库进行回顾性分析。记录详细的临床、实验室、影像学和治疗数据。内分泌功能障碍定义为糖化血红蛋白（Hba1C）≥6.5 g/dl。记录内治疗前后的内分泌功能状态（Hba1C值）以及口服降糖药（OHA）和/或胰岛素的使用需求。
结果 141例患者接受了内镜逆行胰胆管造影术以治疗疼痛（平均年龄：35岁，74.5%为男性）。在内治疗前，60例患者（42.5%）存在病理性内分泌功能障碍。平均HbA1c值为8.46 g/dl（4.5 - 16.1g/dl）。60例患者中，13例（21.6%）仅使用OHA，34例（56.6%）需要胰岛素。13例（21.6%）患者需要OHA和胰岛素联合使用。内治疗后，没有患者同时使用OHA和胰岛素；13例患者中，5例（38.4%）仅使用OHA，而8例（61.5%）患者改用胰岛素。在总共47例需要胰岛素的患者中，15例（约31.9%）患者可以停用胰岛素。内分泌功能障碍有所改善的患者的HbA1c值显著更低（6.38 vs. 8.07 g/dl，p < 0.001），特发性胰腺炎患者的比例更高（73.3% vs. 22.2%，p = 0.004），伴有外分泌功能不全的患者比例更低（13.3% vs. 53.3%，p = 0.007）。
结论 三分之一的患者内分泌功能障碍有所改善。对部分选定的CP患者进行早期导管干预可能有改善血糖状态的潜力。
