The role of endoscopy in patients with chronic pancreatitis

Adler, Douglas G.; Lichtenstein, David R.; Baron, Todd H.; Davila, Raquel E.; Egan, James; Gan, S. Ian; Qureshi, Waqar; Rajan, Elizabeth; Shen, Bo; Zuckerman, Marc J.; Lee, Kenneth K.; VanGuilder, Trina; Fanelli, Robert D.

doi:10.1016/j.gie.2006.02.003

Cited by 129 publications

(70 citation statements)

References 53 publications

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“…Occlusion was seen with the passage of time and migration was present in 10% of patients [30] . Distal migration and impaction on the opposite duodenal wall can cause perforation while proximal migration into the pancreas is a technical challenge for the endoscopist.…”

Section: Endoscopic Management Of Pancreatic Ductal Stricturesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.© 2013 Baishideng. All rights reserved.Key words: Chronic pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic sphincterotomy; Extracorporeal shockwave lithotripsy; Endosonography Core tip: Chronic pancreatitis is a challenge to the therapeutic endoscopist. A patient with chronic pancreatitis can present with ductal calculi, leaks, pseudocysts, strictures, pancreatic malignancy or a biliary obstruction. Endoscopic therapy offers a high rate of success in properly selected patients. It offers many advantages over surgery, which for a long time was considered the gold standard in the treatment of chronic pancreatitis. This chapter deals with the management of chronic pancreatitis associated strictures, calculi, leaks and pseudocysts. The role of endosonography in management of pseudocysts, cannulation of inaccessible ducts and pain relief has also been discussed.Tandan M, Reddy DN. Endotherapy in chronic pancreatitis.

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Section: Endoscopic Management Of Pancreatic Ductal Stricturesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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“…Prospective studies commonly have post-ERCP pancreatitis (PEP) rates two to three times higher than those noted in retrospective studies. However, a variety of criteria have been used to define early or milder pancreatitis [1] . More severe forms of PEP are obvious and rarely escape notice.…”

Section: Definitionsmentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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“…Los objetivos del tratamiento endoscópico son aliviar la obstrucción del flujo del conducto pancreático para disminuir la hipertensión ductal, drenar las colecciones de líquido, aliviar el dolor y prevenir las recaídas 17,28,31 . Las modalidades endoscópicas disponibles son: el tratamiento de las estenosis pancreáticas, de los cálculos ductales pancreáticos, de las estenosis del conducto biliar y de los pseudoquistes 6,29,30 . Las técnicas utilizadas son diversas y no difieren mayormente de las técnicas utilizadas cotidianamente en la endoscopia terapéutica biliar: la papilotomía pancreática, extracción instrumental de cálculos, colocación de endoprótesis, etc.…”

Section: Discussionunclassified