Late acute pancreatitis after pancreaticoduodenectomy: incidence, outcome, and risk factors

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 26; no. 3; pp. 109 - 116
• Main Authors: Yen, Hung‐Hsuan, Ho, Te‐Wei, Wu, Chien‐Hui, Kuo, Ting‐Chun, Wu, Jin‐Ming, Yang, Ching‐Yao, Tien, Yu‐Wen
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01.03.2019
• Subjects: Acute pancreatitis; Pancreaticoduodenectomy; Pancreaticojejunostomy stricture; Pancreatitis; Pancreatoenteric anastomotic stricture; Risk factors; Whipple operation; Acute pancreatitis; Pancreaticojejunostomy stricture; Whipple operation; Pancreaticoduodenectomy; Pancreatoenteric anastomotic stricture
• ISSN: 1868-6974; 1868-6982; 1868-6982
• DOI: 10.1002/jhbp.606

Background The pancreatoenteric anastomotic stricture (PEAS) is a common long‐term complication after pancreaticoduodenectomy (PD), some of which present as acute pancreatitis requiring emergency care. This important topic has never been reported. In this study, we focus on the incidence, radiological features, clinical outcome, and risk factors of late‐occurring acute pancreatitis (LAP) after PD. Methods We retrospectively reviewed a prospectively collected database of 539 patients who underwent PD at a single tertiary referral center between June 2005 and December 2014. Only patients with at least 3 years of follow‐up and available pre‐ and post‐operative images were included. Results Of the 539 patients, 23 (15 [65%] with and eight [35%] without PEAS) were diagnosed with LAP after PD. The cumulative incidence of LAP was 3.6% (1‐year), 4.4% (2‐year), and 5.1% (5‐year). The median time to the first LAP episode was 22 months (range 8–38 months) after PD. All the first and recurrent LAP events were mild in severity and resolved after conservative treatment. Multivariate analysis showed that a history of acute pancreatitis before PD (P = 0.001, HR 5.24, 95% CI 1.95–14.10) and PEAS (P = 0.047, HR 2.75, 95% CI 1.01–7.49) were two significant risk factors. Conclusions We propose using a more conservative treatment for patients who experience LAP after PD. Highlight Yen and colleagues investigated the incidence of late acute pancreatitis after pancreaticoduodenectomy among a large patient cohort and found the significant risk factors to be pancreaticoenteric anastomotic stricture and preoperative acute pancreatitis. They propose using a more conservative treatment for late acute pancreatitis after pancreaticoduodenectomy, especially for the first episode.