The role of endoscopy in the therapy of chronic pancreatitis

• Published in: Baillière's best practice & research. Clinical gastroenterology 2008-01, Vol.22 (1), p.145-165
• Main Authors: Tringali, Andrea, MD, PhD, Boskoski, Ivo, MD, Costamagna, Guido, MD, FACG
• Format: Article
• Language: English
• Subjects: Ampulla of Vater - surgery; Anastomosis, Surgical; Calculi - therapy; Celiac Plexus - surgery; Cholangiopancreatography, Endoscopic Retrograde - methods; chronic pancreatitis; Common Bile Duct Diseases - surgery; Constriction, Pathologic - surgery; cyst-duodenostomy; cyst-gastrostomy; Cysts; endoscopic retrograde cholangiopancreatography; endoscopic therapy; endoscopic ultrasonography; Endosonography; extracorporeal shock wave lithotripsy; Gastroenterology and Hepatology; Humans; Lithotripsy; main pancreatic duct drainage; Mortality; Nerve Block; Pancreas; Pancreas - pathology; Pancreas - surgery; Pancreatic Ducts - pathology; Pancreatic Ducts - surgery; pancreatic pseudocyst; Pancreatic Pseudocyst - surgery; pancreatic sphincterotomy; pancreatic stent; pancreatico-bulbostomy; pancreatico-gastrostomy; Pancreatitis, Chronic - diagnostic imaging; Pancreatitis, Chronic - therapy; Sphincterotomy, Endoscopic - methods; Stomach - surgery
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2007.10.021

Almost all the therapeutic efforts in the treatment of chronic pancreatitis are directed towards pain control. Endoscopic techniques available for this purpose are endoscopic retrograde cholangiopancreatography (combined or not with extracorporeal shock wave lithotripsy) and endoscopic ultrasound. Pancreatic stones and strictures, pancreatic pseudocysts, and common bile duct strictures complicating chronic pancreatitis can be treated by endoscopy. The development of endoscopic ultrasound extended the possibilities in the treatment of pancreatic pseudocysts and main pancreatic duct drainage. Endoscopy is considered the first-line treatment in chronic pancreatitis and can be useful also as a ‘bridge to surgery’. In fact the endoscopic approach to chronic pancreatitis can predict the response to surgical therapy as a definitive treatment. Medical, endoscopic and surgical methods for the management of chronic pancreatitis should all be considered in decision-making, and the best treatment should be chosen case by case and according to the local expertise.