Endoscopic management of chronic pancreatitis

Abstract

Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

Keywords: Biliary strictures; Chronic Pancreatitis; Endoscopic management; Pain; Pancreatic stones; Pseudocysts.

Figure 1

Management of benign strictures includes dilation and stenting. A: Distal pancreatic stricture in a patient with chronic pancreatitis; B: Dilation of the distal pancreatic stricture; C: Placement of a pancreatic stent (8.5 Fr x 12 cm).

Figure 2

Fully-covered self-expandable metal stents. A: Distal biliary stricture in the setting of chronic pancreatitis; B: Placement of a fully covered metal stent (10 mm x 60 mm) draining the bile duct.