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

Main Recommendations

ESGE 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.

• References

• 1 Dumonceau JM, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44: 784-800
• 2 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383-394
• 3 Drewes AM, Bouwense SAW, Campbell CM. et al. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17: 720-731
• 4 Romagnuolo J, Talluri J, Kennard E. et al. Clinical profile, etiology, and treatment of chronic pancreatitis in North American women: analysis of a large multicenter cohort. Pancreas 2016; 45: 934-940
• 5 Díte P, Ruzicka M, Zboril V. et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003; 35: 553-558
• 6 Cahen DL, Gouma DJ, Nio Y. et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356: 676-684
• 7 Cahen DL, Gouma DJ, Laramée P. et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 2011; 141: 1690-1695
• 8 Laramée P, Wonderling D, Cahen DL. et al. Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis. BMJ Open 2013; 3: e003676
• 9 Dumonceau J-M, Costamagna G, Tringali A. et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut 2007; 56: 545-552
• 10 Jiang L, Ning D, Cheng Q. et al. Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis. Int J Surg 2018; 54: 242-247
• 11 Sarner M, Cotton PB. Classification of pancreatitis. Gut 1984; 25: 756-759
• 12 Hookey LC, RioTinto R, Delhaye M. et al. Risk factors for pancreatitis after pancreatic sphincterotomy: a review of 572 cases. Endoscopy 2006; 38: 670-676
• 13 Okolo PI, Pasricha PJ, Kalloo AN. What are the long-term results of endoscopic pancreatic sphincterotomy?. Gastrointest Endosc 2000; 52: 15-19
• 14 Seza K, Yamaguchi T, Ishihara T. et al. A long-term controlled trial of endoscopic pancreatic stenting for treatment of main pancreatic duct stricture in chronic pancreatitis. Hepatogastroenterology 2011; 58: 2128-2131
• 15 Delhaye M, Arvanitakis M, Verset G. et al. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol 2004; 2: 1096-1106
• 16 Tadenuma H, Ishihara T, Yamaguchi T. et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol 2005; 3: 1128-1135
• 17 Adamek HE, Jakobs R, Buttmann A. et al. Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gut 1999; 45: 402-405
• 18 Clarke B, Slivka A, Tomizawa Y. et al. Endoscopic therapy is effective for patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2012; 10: 795-802
• 19 Seven G, Schreiner MA, Ross AS. et al. Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2012; 75: 997-1004.e1
• 20 Hu L-H, Ye B, Yang Y-G. et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones: a prospective study of 214 cases. Pancreas 2016; 45: 298-305
• 21 Kirkegård J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 1366-1372
• 22 Toft J, Hadden WJ, Laurence JM. et al. Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol 2017; 92: 17-23
• 23 Dimastromatteo J, Brentnall T, Kelly KA. Imaging in pancreatic disease. Nat Rev Gastroenterol Hepatol 2017; 14: 97-109
• 24 Zhang T-T, Wang L, Liu H. et al. Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging. Oncotarget 2017; 8: 1744-1759
• 25 Niu X, Das S, Bhetuwal A. et al. Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis a meta-analysis. Chin Med J 2014; 127: 3477-3482
• 26 Fritscher-Ravens A, Brand L, Knöfel WT. et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002; 97: 2768-2775
• 27 Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005; 62: 728-736 quiz 751, 753
• 28 Dumonceau J-M, Deprez PH, Jenssen C. et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017. Endoscopy 2017; 49: 695-714
• 29 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy 2017; 49: 989-1006
• 30 Ohyama H, Mikata R, Ishihara T. et al. Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones. Pancreas 2015; 44: 422-428
• 31 Anaizi A, Hart PA, Conwell DL. Diagnosing chronic pancreatitis. Dig Dis Sci 2017; 62: 1713-1720
• 32 Anderson SW, Soto JA. Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdom Imaging 2009; 34: 55-63
• 33 Kolodziejczyk E, Jurkiewicz E, Pertkiewicz J. et al. MRCP versus ERCP in the evaluation of chronic pancreatitis in children: which is the better choice?. Pancreas 2016; 45: 1115-1119
• 34 Sica GT, Braver J, Cooney MJ. et al. Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 1999; 210: 605-610
• 35 Sarles H, Camarena J, Gomez-Santana C. Radiolucent and calcified pancreatic lithiasis: two different diseases. Role of alcohol and heredity. Scand J Gastroenterol 1992; 27: 71-76
• 36 Ammann RW, Akovbiantz A, Largiader F. et al. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984; 86: 820-828
• 37 Frulloni L, Gabbrielli A, Pezzilli R. et al. Chronic pancreatitis: report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liver Dis 2009; 41: 311-317
• 38 Delhaye M, Vandermeeren A, Baize M. et al. Extracorporeal shock-wave lithotripsy of pancreatic calculi. Gastroenterology 1992; 102: 610-620
• 39 Moole H, Jaeger A, Bechtold ML. et al. Success of extracorporeal shockwave lithotripsy in chronic calcific pancreatitis management: a meta-analysis and systematic review. Pancreas 2016; 45: 651-658
• 40 Farnbacher MJ, Schoen C, Rabenstein T. et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success. Gastrointest Endosc 2002; 56: 501-506
• 41 Suzuki Y, Sugiyama M, Inui K. et al. Management for pancreatolithiasis: a Japanese multicenter study. Pancreas 2013; 42: 584-588
• 42 Inui K, Masamune A, Igarashi Y. et al. Management of pancreatolithiasis: a nationwide survey in Japan. Pancreas 2018; 47: 708-714
• 43 Sherman S, Lehman GA, Hawes RH. et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc 1991; 37: 511-517
• 44 Thomas M, Howell DA, Carr-Locke D. et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol 2007; 102: 1896-1902
• 45 Dumonceau JM, Devière J, Le Moine O. et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc 1996; 43: 547-555
• 46 Tandan M, Reddy DN, Talukdar R. et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc 2013; 78: 726-733
• 47 Vaysse T, Boytchev I, Antoni G. et al. Efficacy and safety of extracorporeal shock wave lithotripsy for chronic pancreatitis. Scand J Gastroenterol 2016; 51: 1380-1385
• 48 Ohara H, Hoshino M, Hayakawa T. et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol 1996; 91: 1388-1394
• 49 Inui K, Tazuma S, Yamaguchi T. et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas 2005; 30: 26-30
• 50 Nguyen-Tang T, Dumonceau J-M. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol 2010; 24: 281-298
• 51 Kondo H, Naitoh I, Ohara H. et al. Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones. Dig Liver Dis 2014; 46: 639-644
• 52 Tandan M, Reddy DN, Santosh D. et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Indian J Gastroenterol 2010; 29: 143-148
• 53 Brand B, Kahl M, Sidhu S. et al. Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis. Am J Gastroenterol 2000; 95: 3428-3438
• 54 Korpela T, Udd M, Tenca A. et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol 2016; 51: 866-871
• 55 Choi EK, McHenry L, Watkins JL. et al. Use of intravenous secretin during extracorporeal shock wave lithotripsy to facilitate endoscopic clearance of pancreatic duct stones. Pancreatology 2012; 12: 272-275
• 56 Merrill JT, Mullady DK, Early DS. et al. Timing of endoscopy after extracorporeal shock wave lithotripsy for chronic pancreatitis. Pancreas 2011; 40: 1087-1090
• 57 Li B-R, Liao Z, Du T-T. et al. Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts. Gastrointest Endosc 2016; 84: 69-78
• 58 Li B-R, Liao Z, Du T-T. et al. Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy. Endoscopy 2014; 46: 1092-1100
• 59 Delhaye M. Extracorporeal shock wave lithotripsy for pancreatic stones – UpToDate. Accessed June 5 2018. https://www.uptodate.com/contents/extracorporeal-shock-wave-lithotripsy-for-pancreatic-stones?search = ESWL%20pancreas&source = search_result&selectedTitle = 1~150&usage_type = default&display_rank = 1
• 60 Crossley GH, Poole JE, Rozner MA. et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) expert consensus statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management. Heart Rhythm 2011; 8: 1114-1154
• 61 Beyna T, Neuhaus H, Gerges C. Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? Systematic review. Dig Endosc 2018; 30: 29-37
• 62 Attwell AR, Brauer BC, Chen YK. et al. Endoscopic retrograde cholangiopancreatography with per oral pancreatoscopy for calcific chronic pancreatitis using endoscope and catheter-based pancreatoscopes: a 10-year single-center experience. Pancreas 2014; 43: 268-274
• 63 Delhaye M, Matos C, Devière J. Endoscopic management of chronic pancreatitis. Gastrointest Endosc Clin N Am 2003; 13: 717-742
• 64 Kwon C-I, Gromski MA, Sherman S. et al. Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis. Endoscopy 2017; 49: 371-377
• 65 Smits ME, Badiga SM, Rauws EA. et al. Long-term results of pancreatic stents in chronic pancreatitis. Gastrointest Endosc 1995; 42: 461-467
• 66 Eleftheriadis N, Dinu F, Delhaye M. et al. Long-term outcome after pancreatic stenting in severe chronic pancreatitis. Endoscopy 2005; 37: 223-230
• 67 Ponchon T, Bory RM, Hedelius F. et al. Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. Gastrointest Endosc 1995; 42: 452-456
• 68 Cremer M, Devière J, Delhaye M. et al. Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy 1991; 23: 171-176
• 69 Ishihara T, Yamaguchi T, Seza K. et al. Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis. Scand J Gastroenterol 2006; 41: 744-750
• 70 Topazian M, Aslanian H, Andersen D. Outcome following endoscopic stenting of pancreatic duct strictures in chronic pancreatitis. J Clin Gastroenterol 2005; 39: 908-911
• 71 Jafri M, Javed S, Sachdev A. et al. Efficacy of endotherapy in the treatment of pain associated with chronic pancreatitis: a systematic review and meta-analysis. JOP 2017; 18: 125-132
• 72 Binmoeller KF, Jue P, Seifert H. et al. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy 1995; 27: 638-644
• 73 Farnbacher MJ, Mühldorfer S, Wehler M. et al. Interventional endoscopic therapy in chronic pancreatitis including temporary stenting: a definitive treatment?. Scand J Gastroenterol 2006; 41: 111-117
• 74 Sasahira N, Tada M, Isayama H. et al. Outcomes after clearance of pancreatic stones with or without pancreatic stenting. J Gastroenterol 2007; 42: 63-69
• 75 Costamagna G, Bulajic M, Tringali A. et al. Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results. Endoscopy 2006; 38: 254-259
• 76 Bove V, Tringali A, Valerii G. et al. Endoscopic dilation of pancreatic duct strictures in chronic pancreatitis with multiple plastic stents: results in 48 patients. Gastrointest Endosc 2017; 85: AB236
• 77 Eisendrath P, Devière J. Expandable metal stents for benign pancreatic duct obstruction. Gastrointest Endosc Clin N Am 1999; 9: 547-554
• 78 Shen Y, Liu M, Chen M. et al. Covered metal stent or multiple plastic stents for refractory pancreatic ductal strictures in chronic pancreatitis: a systematic review. Pancreatology 2014; 14: 87-90
• 79 Matsubara S, Sasahira N, Isayama H. et al. Prospective pilot study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: long-term outcomes. Endosc Int Open 2016; 4: E1215-E1222
• 80 Oh D, Lee JH, Song TJ. et al. Long-term outcomes of 6-mm diameter fully covered self-expandable metal stents in benign refractory pancreatic ductal stricture. Dig Endosc 2018; 30: 508-515
• 81 Tringali A, Vadalà di Prampero SF, Landi R. et al. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc 2018; 88: 939-946
• 82 Morgan DE, Smith JK, Hawkins K. et al. Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency. Am J Gastroenterol 2003; 98: 821-826
• 83 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
• 84 Rösch T, Daniel S, Scholz M. et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy 2002; 34: 765-771
• 85 Kawaguchi Y, Lin J-C, Kawashima Y. et al. Risk factors for migration, fracture, and dislocation of pancreatic stents. Gastroenterol Res Pract 2015; 2015: 365457
• 86 Kim MH, Myung SJ, Kim YS. et al. Routine biliary sphincterotomy may not be indispensable for endoscopic pancreatic sphincterotomy. Endoscopy 1998; 30: 697-701
• 87 Weber A, Schneider J, Neu B. et al. Endoscopic stent therapy for patients with chronic pancreatitis: results from a prospective follow-up study. Pancreas 2007; 34: 287-294
• 88 Vitale GC, Cothron K, Vitale EA. et al. Role of pancreatic duct stenting in the treatment of chronic pancreatitis. Surg Endosc 2004; 18: 1431-1434
• 89 Farnbacher MJ, Radespiel-Tröger M, König MD. et al. Pancreatic endoprostheses in chronic pancreatitis: criteria to predict stent occlusion. Gastrointest Endosc 2006; 63: 60-66
• 90 He Y-X, Xu H-W, Sun X-T. et al. Endoscopic management of early-stage chronic pancreatitis based on M-ANNHEIM classification system: a prospective study. Pancreas 2014; 43: 829-833
• 91 Kim CH, Bang S, Song KH. et al. Analysis of the effects of stent insertion and the factors related to stent retrieval in chronic pancreatitis accompanying main pancreatic duct obstruction. Gut Liver 2007; 1: 063-067
• 92 Boursier J, Quentin V, Le Tallec V. et al. Endoscopic treatment of painful chronic pancreatitis: Evaluation of a new flexible multiperforated plastic stent. Gastroenterol Clin Biol 2008; 32: 801-805
• 93 Mangiavillano B, Pagano N, Baron TH. et al. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World J Gastrointest Endosc 2016; 8: 143-156
• 94 Dumonceau JM, Heresbach D, Devière J. et al. Biliary stents: models and methods for endoscopic stenting. Endoscopy 2011; 43: 617-626
• 95 Buscaglia JM, DiMaio CJ, Pollack MJ. et al. Are large side holes associated with reduced rates of pancreatic stent occlusion? Results of a prospective study. JOP 2009; 10: 496-500
• 96 Sauer BG, Gurka MJ, Ellen K. et al. Effect of pancreatic duct stent diameter on hospitalization in chronic pancreatitis: does size matter?. Pancreas 2009; 38: 728-731
• 97 Hirota M, Asakura T, Kanno A. et al. Long-period pancreatic stenting for painful chronic calcified pancreatitis required higher medical costs and frequent hospitalizations compared with surgery. Pancreas 2011; 40: 946-950
• 98 Weber A, Schneider J, Neu B. et al. Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol 2013; 19: 715-720
• 99 Cahen DL, Van der Merwe SW, Laleman W. et al. A biodegradable non-covered self-expandable stent to treat pancreatic duct strictures in chronic pancreatitis: a proof of principle. Gastrointest Endosc 2018; 87: 486-491
• 100 Ikenberry SO, Sherman S, Hawes RH. et al. The occlusion rate of pancreatic stents. Gastrointest Endosc 1994; 40: 611-613
• 101 Oh D, Park DH, Cho MK. et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc 2016; 83: 366-373.e2
• 102 Deviere J. EUS-guided pancreatic duct drainage: a rare indication in need of prospective evidence. Gastrointest Endosc 2017; 85: 178-180
• 103 François E, Kahaleh M, Giovannini M. et al. EUS-guided pancreaticogastrostomy. Gastrointest Endosc 2002; 56: 128-133
• 104 Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases. Gastrointest Endosc 2004; 59: 100-107
• 105 Will U, Fueldner F, Thieme A-K. et al. Transgastric pancreatography and EUS-guided drainage of the pancreatic duct. J Hepatobil Pancreat Surg 2007; 14: 377-382
• 106 Kahaleh M, Hernandez AJ, Tokar J. et al. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 2007; 65: 224-230
• 107 Brauer BC, Chen YK, Fukami N. et al. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc 2009; 70: 471-479
• 108 Tessier G, Bories E, Arvanitakis M. et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007; 65: 233-241
• 109 Tyberg A, Sharaiha RZ, Kedia P. et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 2017; 85: 164-169
• 110 Chen Y-I, Levy MJ, Moreels TG. et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85: 170-177
• 111 Barthet M, Lamblin G, Gasmi M. et al. Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 2008; 67: 245-252
• 112 Shah RJ, Shah JN, Waxman I. et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
• 113 Yoon SB, Lee IS, Choi MG. Metal versus plastic stents for drainage of pancreatic fluid collection: A meta-analysis. United European Gastroenterol J 2018; 6: 729-738
• 114 Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part II: natural history. JOP 2004; 5: 64-70
• 115 Gouyon B, Lévy P, Ruszniewski P. et al. Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut 1997; 41: 821-825
• 116 Lerch MM, Stier A, Wahnschaffe U. et al. Pancreatic pseudocysts: observation, endoscopic drainage, or resection?. Dtsch Arztebl Int 2009; 106: 614-621
• 117 Law R, Baron TH. Endoscopic management of pancreatic pseudocysts and necrosis. Expert Rev Gastroenterol Hepatol 2015; 9: 167-175
• 118 Khan M, Hammad T, Khan Z. et al. Endoscopic versus percutaneous management for symptomatic pancreatic fluid collections: a systematic review and meta-analysis. Endosc Int Open 2018; 06: E474-E483
• 119 Nealon WH, Walser E. Main pancreatic ductal anatomy can direct choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage). Ann Surg 2002; 235: 751-758
• 120 Zhao X, Feng T, Ji W. Endoscopic versus surgical treatment for pancreatic pseudocyst. Dig Endosc 2016; 28: 83-91
• 121 Redwan AA, Hamad MA, Omar MA. Pancreatic pseudocyst dilemma: cumulative multicenter experience in management using endoscopy, laparoscopy, and open surgery. J Laparoendosc Adv Surg Tech A 2017; 27: 1022-1030
• 122 Morgan DE, Baron TH, Smith JK. et al. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 1997; 203: 773-778
• 123 Kamal A, Singh VK, Akshintala VS. et al. CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012. Abdom Imaging 2015; 40: 1608-1616
• 124 Rana SS, Chaudhary V, Sharma R. et al. Comparison of abdominal ultrasound, endoscopic ultrasound and magnetic resonance imaging in detection of necrotic debris in walled-off pancreatic necrosis. Gastroenterol Rep (Oxf) 2016; 4: 50-53
• 125 Bang JY, Wilcox CM, Trevino J. et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol 2013; 28: 1725-1732
• 126 Arvanitakis M, Delhaye M, Bali MA. et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609-619
• 127 Gillams AR, Kurzawinski T, Lees WR. Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol 2006; 186: 499-506
• 128 Costamagna G, Mutignani M, Ingrosso M. et al. Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy 2001; 33: 317-322
• 129 Drake LM, Anis M, Lawrence C. Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 2012; 46: 696-699
• 130 Amin S, Yang DJ, Lucas AL. et al. There Is no advantage to transpapillary pancreatic duct stenting for the transmural endoscopic drainage of pancreatic fluid collections: a meta-analysis. Clin Endosc 2017; 50: 388-394
• 131 Telford JJ, Farrell JJ, Saltzman JR. et al. Pancreatic stent placement for duct disruption. Gastrointest Endosc 2002; 56: 18-24
• 132 Varadarajulu S, Noone TC, Tutuian R. et al. Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc 2005; 61: 568-575
• 133 Panamonta N, Ngamruengphong S, Kijsirichareanchai K. et al. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol 2012; 24: 1355-1362
• 134 Bang JY, Wilcox CM, Trevino JM. et al. Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc 2014; 28: 2877-2883
• 135 Cahen D, Rauws E, Fockens P. et al. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 2005; 37: 977-983
• 136 Lin H, Zhan X-B, Sun S-Y. et al. Stent selection for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a multicenter study in China. Gastroenterol Res Pract 2014; 2014: 193562
• 137 Bang JY, Hawes R, Bartolucci A. et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: A systematic review. Dig Endosc 2015; 27: 486-498
• 138 Panwar R, Singh PM. Efficacy and safety of metallic stents in comparison to plastic stents for endoscopic drainage of peripancreatic fluid collections: a meta-analysis and trial sequential analysis. Clin J Gastroenterol 2017; 10: 403-414
• 139 Hammad T, Khan MA, Alastal Y. et al. Efficacy and safety of lumen-apposing metal stents in management of pancreatic fluid collections: are they better than plastic stents? a systematic review and meta-analysis. Dig Dis Sci 2018; 63: 289-301
• 140 Chen Y-I, Khashab MA, Adam V. et al. A cost-effectiveness analysis comparing lumen apposing metal stents with plastic stents in the management of pancreatic pseudocysts. Gastroenterology 2017; 152: S132
• 141 Arvanitakis M, Dumonceau J-M, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
• 142 Téllez-Aviña FI, Casasola-Sánchez LE, Ramírez-Luna MÁ. et al. Permanent indwelling transmural stents for endoscopic treatment of patients with disconnected pancreatic duct syndrome: long-term results. J Clin Gastroenterol 2018; 52: 85-90
• 143 Rana SS, Bhasin DK, Sharma R. et al. Factors determining recurrence of fluid collections following migration of intended long term transmural stents in patients with walled off pancreatic necrosis and disconnected pancreatic duct syndrome. Endosc Ultrasound 2015; 4: 208-212
• 144 Bang JY, Hasan M, Navaneethan U. et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66: 2054-2056
• 145 Bang JY, Navaneethan U, Hasan MK. et al. Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut 2018; DOI: 10.1136/gutjnl-2017–315335.
• 146 Puga M, Consiglieri C, Busquets J. et al. Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study. Endoscopy 2018; 10: 1022-1026
• 147 Bernades P, Baetz A, Lévy P. et al. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci 1992; 37: 340-346
• 148 Sriram PV, Kaffes AJ, Rao GV. et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels. Endoscopy 2005; 37: 231-235
• 149 Rana SS, Sharma R, Ahmed SU. et al. Endoscopic ultrasound-guided transmural drainage of walled-off pancreatic necrosis in patients with portal hypertension and intra-abdominal collaterals. Indian J Gastroenterol 2017; 36: 400-404
• 150 Evans RP, Mourad MM, Pall G. et al. Pancreatitis: Preventing catastrophic haemorrhage. World J Gastroenterol 2017; 23: 5460-5468
• 151 Delhaye M, Matos C, Deviere J. Endoscopic technique for the management of pancreatitis and its complications. Best Pract Res Clin Gastroenterol 2004; 18: 155-181
• 152 Rana SS, Kumar A, Lal A. et al. Safety and efficacy of angioembolisation followed by endoscopic ultrasound guided transmural drainage for pancreatic fluid collections associated with arterial pseudoaneurysm. Pancreatology 2017; 17: 658-662
• 153 Nykänen T, Udd M, Peltola EK. et al. Bleeding pancreatic pseudoaneurysms: management by angioembolization combined with therapeutic endoscopy. Surg Endosc 2017; 31: 692-703
• 154 Abdallah AA, Krige JEJ, Bornman PC. Biliary tract obstruction in chronic pancreatitis. HPB (Oxford) 2007; 9: 421-428
• 155 Frey CF, Suzuki M, Isaji S. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 1990; 14: 59-69
• 156 Regimbeau J-M, Fuks D, Bartoli E. et al. A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis. Surg Endosc 2012; 26: 2902-2908
• 157 Dumonceau J-M, Tringali A, Papanikolaou I. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy 2018; 50: 910-930
• 158 Siriwardana HPP, Siriwardena AK. Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture. Ann Surg 2005; 242: 10-19
• 159 Haapamäki C, Kylänpää L, Udd M. et al. Randomized multicenter study of multiple plastic stents vs. covered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis. Endoscopy 2015; 47: 605-610
• 160 Ohyama H, Mikata R, Ishihara T. et al. Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis. World J Gastrointest Endosc 2017; 9: 12-18
• 161 Pozsár J, Sahin P, László F. et al. Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents. J Clin Gastroenterol 2004; 38: 118-123
• 162 Kiehne K, Fölsch UR, Nitsche R. High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance. Endoscopy 2000; 32: 377-380
• 163 Gu Y, Wang L, Zhao L. et al. Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study. BMC Gastroenterol 2016; 16: 105
• 164 Ooi M, Liu K, Sanagapalli S. et al. The effects of a biliary stent registry on complications related to biliary stenting. Gastrointest Endosc 2015; 81: AB398
• 165 Dumonceau JM, Hassan C, Riphaus A. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629