November 12, 2014
Notes: Talukdar, Rupjyoti
Reddy, D Nageshwar
World J Gastroenterol. 2013 Oct 14;19(38):6319-28. doi: 10.3748/wjg.v19.i38.6319.
Author Address: Rupjyoti Talukdar, D Nageshwar Reddy, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad 500082, India.
Reference Type: Journal Article
Record Number: 4879Author: Tandan, M. and Nageshwar Reddy, D.
Title: Endotherapy in chronic pancreatitis
Journal: World J Gastroenterol
Date: Oct 7
Short Title: Endotherapy in chronic pancreatitis
Alternate Journal: World journal of gastroenterology : WJG
ISSN: 2219-2840 (Electronic)
Accession Number: 24115811
Keywords: Cholangiopancreatography, Endoscopic Retrograde
*Endoscopy, Digestive System/instrumentation
Patient Care Team
Abstract: Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. Pancreatic ductal strictures are managed by single large bore stents. Multiple stents are placed for refractory strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.