Current status of endotherapy for chronic pancreatitis

Abstract

Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.

Fig. 1

CT image shows the presence of hyperdense pancreatic stones at the head of the pancreas, with upstream dilation of the pancreatic and biliary ducts. A small (4 cm) pancreatic pseudocyst is seen at the tail region of the pancreas.

Fig. 2

CT image shows the resolution of both the dilated ducts and pseudocyst, following extracorporeal shockwave lithotripsy and endotherapy.

Fig. 3

Pancreatogram shows a main pancreatic duct stricture at the pancreatic genu, with upstream dilation of the main duct and its side branches.

Fig. 4

Cholangiogram shows a stricture of the intrapancreatic portion of the common bile duct.