Recent advances in the diagnosis and management of chronic pancreatitis

Kwon, Chang-Il; Cho, Jae Hee; Choi, Sung Hoon; Ko, Kwang Hyun; Tirkes, Temel; Gromski, Mark A.; Lehman, Glen A.

doi:10.3904/kjim.2019.051

Cited by 21 publications

(16 citation statements)

References 97 publications

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“…The traditional management approach to CP favoured a classical pathway of medical treatment followed by endoscopic intervention and, finally, surgery if previous treatments had failed [22]. The primary objective for surgery is to avoid a state of chronic, intractable pain which leads to a state of continual analgesic abuse and dependence.…”

Section: Timing Of Surgerymentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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Background Chronic pancreatitis (CP) remains a complex condition resulting in significant morbidity and suffering in patients, often over a long period of time. Treatment is mostly centred on a conservative approach, with a variety of more aggressive options being trialled over the years utilising numerous endoscopic and surgical techniques. Methods This review provides an overview of current treatment options for CP, the literature search was performed via PubMed. Personal experiences from the authors on how to approach the disease from the surgeon's perspective are added. The outline includes pathophysiologic aspects, classifications and patientcentred surgical approaches. Results There has not been a standardized treatment for CP so far as clinical and radiological appearance of the disease have a wide range due to great heterogeneity of this complex disease; therefore, level 1 evidence for treatment of CP remains low. More recently, different approaches to surgical management have been trialled. With personalized surgery, long-term pain relief is achievable in up to 90% with low morbidity. Autologous islet cell transplantation is a feasible option in selected patients to avoid endocrine insufficiency. Conclusion A tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.

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Section: Timing Of Surgerymentioning

confidence: 99%

The role of surgery in chronic pancreatitis

et al. 2019

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“…Direct PFT is conducted by determining the pancreas enzyme output after stimulation with cholecystokinin (CCK). The combination of secretin-stimulated MRI (s-MRI) and EUS-based PFT allows for the assessment of the bicarbonate concentration in the pancreatic juices as well as an improved morphological analysis[ 70 ]. S-MRI is considered to be a safe and non-invasive technique that enhances the visualisation of the ductal system by stimulating the bicarbonate-rich fluid filling the MPD and its side branches.…”

Section: Pancreatic Function Testingmentioning

confidence: 99%

Comprehensive review of diagnostic modalities for early chronic pancreatitis

Ge¹,

Dietrich²,

Bhutani³

et al. 2021

WJG

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Chronic pancreatitis (CP) is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction. However, CP is difficult to diagnose at an early stage. Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP, although no unified diagnostic standards have been established. In the past, the diagnosis was mainly based on imaging, and no comprehensive evaluations were performed. This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP.

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“…When the levels of each are lower than average, an accurate CP diagnosis is nearly 100%, except for in patients who have undergone partial or total pancreatectomy. [27] A serum trypsin level of < 20 ng / mL may also serve as a useful marker of CP, with a sensitivity ranging from 33%-65%. [9] The secretin stimulation test has been shown to be the most reliable test due to its high specificity and sensitivity.…”

Section: Pancreatic Function Testsmentioning

confidence: 99%

Chronic pancreatitis - an update

Gobishangar

2021

Jaffna Med. J.

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Chronic pancreatitis (CP) is a progressive inflammatory process that causes irreversible damage to the pancreas due to fibrosis and scarring. The incidence of CP varies among regions. Alcohol consumption and smoking are the main aetiological factors of CP. In addition, autoimmune diseases, hereditary and genetic factors, and tropical CP also contribute to this condition. Though no single mechanism has been shown to initiate CP pathogenesis, this disease ultimately results in fibrosis, scarring, and insufficiency in the pancreas. Chronic upper abdominal pain, steatorrhea, malnutrition, and diabetes mellitus are the main clinical features of CP. Detecting this disease at an early stage is difficult unless it is explicitly checked for due to strong suspicions. Nevertheless, pancreatic function tests, imaging, and endoscopy are used to diagnose CP. Pain management, exocrine supplementation, diabetic management, and endoscopic or surgical drainage and resection procedures are essential for managing CP. Early surgical intervention can improve the remaining pancreatic reserve, delay pancreatic failure, and improve the quality of life of patients with this disease.

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Recent advances in the diagnosis and management of chronic pancreatitis

Cited by 21 publications

References 97 publications

The role of surgery in chronic pancreatitis

The role of surgery in chronic pancreatitis

Comprehensive review of diagnostic modalities for early chronic pancreatitis

Chronic pancreatitis - an update

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