Su1425 Efficacy of Endotherapy in Chronic Pancreatitis Pain: A Systemic Review and Meta-Analysis

Jafri, Mikram; Sadiq, Javed N.; Parakh, Pallav; Gress, Frank G.; Lee, David S.

doi:10.1016/j.gie.2011.03.478

Cited by 18 publications

(27 citation statements)

References 27 publications

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“…After temporary insertion of a single plastic stent in the MPD, stricture resolution was achieved in 9 % [68] to 50 % [6] of 145 patients in five studies [6, 67 -70] but this is not requir-ed for long-term pain relief [67]. Long-term pain relief was reported in 67.5 % of 536 patients (95 % confidence interval [CI] 51.5 % -80.2 %) in a meta-analysis of 9 studies [71]. The followup duration after stent removal was not calculated but in most studies it was ≥ 24 months, the period during which almost all pain relapses occur [6, 14, 66, 70, 72 -74].…”

Section: Pancreatic Stricturesmentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

et al. 2019

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Main RecommendationsESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

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Section: Pancreatic Stricturesmentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

et al. 2019

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“…Stents are then left in place for 6-12 months before removal. The initial case series using this technique demonstrated resolution of strictures in 18 of 19 treated patients with a very robust 38-month follow-up period [38]. Based on these results, multiple pancreatic stents can be considered for refractory strictures, and many practitioners now utilize this as primary therapy [39].…”

Section: Multiple Pancreatic Stentsmentioning

confidence: 99%

“…Stricture resolution can be achieved after placement of a single pancreatic stent in up to 50% of patients. However, stricture resolution is not necessary to achieve clinical therapeutic success as long-term pain relief was seen in 67.5% of patients in a large meta-analysis [38].…”

Section: Stentingmentioning

confidence: 99%

Treatment of Chronic Obstructive Pancreatitis

Larsen

Kozarek

2020

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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The endoscopic treatment of chronic obstructive pancreatitis is contingent upon the coexistence of pancreatic duct calculi or the upstream complication of ductal disruption, to include pancreatic pseudocyst, pancreatic ascites, or pancreaticoenteric fistula. Treatment presupposes pancreatic sphincterotomy, catheter, or balloon dilation and the placement of one or more PD endoprostheses. Concomitant calculi require removal, often with the help of electrohydraulic, laser, mechanical, or extracorporeal lithotripsy and, at times, drainage of upstream extraductal fluid collections. More recently, self-expandable stents have been

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“…Altogether 68 patients had endoscopic therapy: pancreatic sphincterotomy (100%), PD stenting (52%), and stone extraction (23.4%). Stents were exchanged every 2-4 months with a median stenting time of 16 months (range of [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In a surgery group, 61 patients underwent resections (80%) and 15 cases underwent draining procedure (20%).…”

Section: Endoscopic Therapy Versus Surgerymentioning

confidence: 99%

The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis

2020

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Chronic pancreatitis is a long-term illness leading to hospital admissions and readmission. This disease is often caused by heavy alcohol consumption and smoking. Patients with chronic pancreatitis suffer from acute or chronic pain episodes, recurrent pancreatitis, and complications, such as pseudocysts, biliary duct strictures, and pancreatic duct fistulas. Pancreatic duct strictures and stones may increase intraductal pressure and cause pain. Endoscopic therapy is aiming at decompressing the pressure and relieving the pain, most commonly with pancreatic duct stents and pancreatic duct stone retrieval. Early surgery is another option to treat the pain. In addition, endotherapy has been successful in treating complications related to chronic pancreatitis. The therapy should be individually chosen in a multidisciplinary meeting. Endoscopic therapy and surgery as treatment options for chronic pancreatitis are discussed in this review.

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Su1425 Efficacy of Endotherapy in Chronic Pancreatitis Pain: A Systemic Review and Meta-Analysis

Cited by 18 publications

References 27 publications

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Treatment of Chronic Obstructive Pancreatitis

The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis

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