New developments in diagnosis and non‐surgical treatment of chronic pancreatitis

Abstract

Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, firstline treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented.

Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis

“…At the late stage of CP, destruction of exocrine and endocrine functions of pancreas would lead to absorptive disorders and diabetes mellitus12. The concept of “early CP” was proposed with specific diagnosis criteria, and its clinical value has drawn increasing attention13.…”

Successful endoscopic removal of a rare, large impacted pancreatic duct stone using grasping forceps

“…The mechanism of pain is multifactorial involving combinations of factors, and pancreatic ductal hypertension can be the primary contributor. [ 9 ] Persistent epigastric pain is the main symptom of PDSs, [ 10 ] and it often leads to use of analgesic drugs, loss of weight, inability to work, and reduced quality of life, and it can induce other complications, such as diabetes, steatorrhea, and jaundice. In addition, PDSs are significantly related to pancreatic carcinoma.…”

Inonotus obliquus polysaccharide regulates gut microbiota of chronic pancreatitis in mice

“…Chronic pancreatitis (CP) is a progressive and permanent destruction of the pancreas leading to insufficient exocrine and endocrine, and often chronic disabling pain. The complications of CP commonly include diabetes mellitus, cholangitis, ascites and even carcinoma of pancreas (Inui et al 2013 ; Phillips 2012 ). In developed countries, CP incidence ranges from 3.5 to 10 per 100,000 populations, while the unhealthy lifestyle has caused a gradual rise in CP (Witt et al 2007 ).…”