Conservative Treatment of Chronic Pancreatitis

Abstract

Background: Chronic pancreatitis is a progressive inflammatory disease giving rise to several complications that need to be treated accordingly. Because pancreatic surgery has significant morbidity and mortality, less invasive therapy seems to be an attractive option. Aim: This paper reviews current state-of-the-art strategies to treat chronic pancreatitis without surgery and the current guidelines for the medical therapy of chronic pancreatitis. Results: Endoscopic therapy of complications of chronic pancreatitis such as pain, main pancreatic duct strictures and stones as well as pseudocysts is technically feasible and safe. The long-term outcome, however, is inferior to definitive surgical procedures such as resection or drainage. On the other hand, the medical therapy of pancreatic endocrine and exocrine insufficiency is well established and evidence based. Conclusions: Endoscopic therapy may be an option to bridge for surgery and in children/young adolescents and those unfit for surgery. Pain in chronic pancreatitis as well as treatment of pancreatic exocrine insufficiency follows established guidelines.

Clinical Significance of Postoperative Antibiotic Treatment for Positive Islet Cultures After Total Pancreatectomy With Islet Autotransplantation

“…First-line management thus includes lifestyle interventions along with medical and endoscopic therapies. [6][7][8][9] However, surgery continues to play a pivotal role in patients failing medical and/or endoscopic management.…”

“…The goal of treatment in CP is avoidance of triggers, preservation of endocrine and exocrine function, and pain management with narcotic avoidance while maintaining quality of life. First-line management thus includes lifestyle interventions along with medical and endoscopic therapies 6–9 . However, surgery continues to play a pivotal role in patients failing medical and/or endoscopic management.…”