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.

Risk factors and nomogram for pancreatic pseudocysts in chronic pancreatitis: A cohort of 1998 patients

“…If the pharmacotherapy is ineffective or the PPC is infected, endoscopic drainage is needed. Endoscopic therapy of PPCs consists of inserting a drain from the digestive lumen into the PPC, through the digestive wall, the papilla, or a combination of these routes, which is the leading therapy for PPCs with a morbidity of 13% and mortality of 0.3% . Surgical drainage is only performed when the pharmacotherapy and endoscopic therapy were both ineffective or additional vascular complications occurred .…”

“…12,17 Surgical drainage is only performed when the pharmacotherapy and endoscopic therapy were both ineffective or additional vascular complications occurred. 12,17 The 3-month screening strategy based on the PPCpredicting nomogram makes it possible to diagnose asymptomatic PPCs, and medical conservative therapy can be used to help the remission of PPCs in the early stage. The early diagnosis and management of PPCs can also prevent severe adverse events, such as vascular complications, hemorrhage, and shock.…”

“…Even more severely, hemorrhage, intracystic bleeding and sudden rupture of the PPC can lead to shock or even be fatal. Moreover, PPCs have a low rate (0–9%) of spontaneous resolution in CP . If PPCs persist for more than 12 weeks, spontaneous remission is very improbable with additional adverse events occurring in up to 60% of cases .…”

“…If PPCs persist for more than 12 weeks, spontaneous remission is very improbable with additional adverse events occurring in up to 60% of cases . For PPCs without spontaneous remission, percutaneous, endoscopic, or surgical approaches are needed, which are associated with higher risks of adverse events, longer stay in hospital, and larger cost …”

“…13 For PPCs without spontaneous remission, percutaneous, endoscopic, or surgical approaches are needed, which are associated with higher risks of adverse events, longer stay in hospital, and larger cost. 2,5,12,[14][15][16][17] The risk factor identification and prediction may help distinguish the high-risk population of PPCs in CP. Early diagnosis and management of PPCs can be achieved by detecting and screening these patients.…”