Chronic pancreatitis: Novel concepts in diagnostics and treatment

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas. The most prominent symptom is abdominal pain, which often leads to recurrent hospitalizations, absence of work, multiple interventions, and opioid addiction. Ten years after onset of the disease, more than half of the patients are still suffering from pain. The ongoing inflammation often leads to fibrosis and pancreatic function loss. Within 5 years, 50% of the patients becomes endocrine insufficient and 80% exocrine insufficient.
This thesis is divided in three parts. The first part focuses on the diagnostics in CP, in which we describe the diagnostic accuracy of imaging modalities for the diagnosis of CP, compare CT with MRI in patients with CP, and compare diagnostic tools for CP.
The second part explores the natural course of CP. We describe the nationwide prospective Dutch Chronic Pancreatitis Registry (CARE), and the long-term outcomes in terms of recurrent pancreatitis and progression to CP in a large cohort of patients with a first acute pancreatitis episode.
The third part evaluates the treatment of CP, where we evaluate the role of preoperative opioid use on the success of thoracoscopic splanchnicectomy in terms of long-term pain relief, and describe a randomized controlled multicenter trial, which evaluates the benefits, risks and costs of early surgical intervention: the Early Surgery versus Optimal Current Step-up Practice for Chronic Pancreatitis (ESCAPE) – trial.