The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: Part 2 (treatment)

Abstract

Chronic pancreatitis (CP) is a complex disease with a wide range of clinical manifestations. This range comprises from asymptomatic patients to patients with disabling symptoms or complications. The management of CP is frequently different between geographic areas and even medical centers. This is due to the paucity of high quality studies and clinical practice guidelines regarding its diagnosis and treatment. The aim of the Spanish Pancreatic Club was to give current evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. These experts were selected according to clinical and research experience in CP. A list of questions was made and two experts reviewed each question. A draft was later produced and discussed with the entire panel of experts in a face-to-face meeting. The level of evidence was based on the ratings given by the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus, recommendations were given regarding the management of pain, pseudocysts, duodenal and biliary stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.

Endoscópic Peri Pancreatic Fluid Collection Drainage Guided by USE in a Highly Complex Hospital in Lima, Peru. A First National Case Series

“…As for necrotizing pancreatitis, indications are usually infection with clinical deterioration or persistent organic failure (for several weeks after the onset of acute pancreatitis) without infection or symptomatic collection (gastrointestinal or biliary obstruction) [9]; while the absolute contraindications for endoscopic drainage are non-encapsulated collections (although there are reports of intervention in these ones), collections located more than 1 cm away from the gastrointestinal tract and the presence of pseudoaneurysms [10].…”

Endoscopic Treatment of Pancreatic Diseases

“…After endotherapy, the number of pain-related hospitalizations and the need for analgesics decreased, but patients' quality of life was not improved significantly [89,96,109]. According to the Spanish Pancreatic Club's recommendations for the diagnosis and treatment of CP, endoscopic decompression treatment is less effective and has shorter-term effects compared to surgery [88]. Endoscopic pain treatment has been shown to be effective for patients with a dilated MPD, particularly when various endoscopic techniques are combined [88,89].…”

“…According to the Spanish Pancreatic Club's recommendations for the diagnosis and treatment of CP, endoscopic decompression treatment is less effective and has shorter-term effects compared to surgery [88]. Endoscopic pain treatment has been shown to be effective for patients with a dilated MPD, particularly when various endoscopic techniques are combined [88,89]. Reference [88] shows also some limitations of endoscopic treatment.…”

“…Endoscopic pain treatment has been shown to be effective for patients with a dilated MPD, particularly when various endoscopic techniques are combined [88,89]. Reference [88] shows also some limitations of endoscopic treatment. Better pain control following surgery compared to endoscopic therapy was observed in randomized clinical trials, but both endoscopic and surgical therapy had been tested in a randomized trial versus medical therapy.…”

“…ESWL is now accepted as the standard of care in treatment of MPD stones. ESWL is highly effective at fragmenting radiopaque and radiolucent stones with high level of spontaneous elimination of stone fragments and pain relief [83,86,88,90,101]. In ESGE Guideline [86], successful stone fragmentation following ESWL has been defined as stones broken into fragments ≤2 or 3 mm, or by the demonstration of a decreased stone density at X-ray, an increased stone surface, and a heterogeneity of the stone which may fill the MPD and adjacent side branches.…”