Pharmacological treatment and/or temporary pancreatic stenting can reduce the risk
of pancreatitis after endoscopic retrograde cholangiopancreatography. Potential candidates
are patients who are at high risk for this complication. Extensive diagnostic work-up
is needed for patients with acute recurrent pancreatitis before treatment can be planned.
Endoscopic pancreatic sphincterotomy or temporary stenting, or both, appear to be
beneficial in idiopathic recurrent pancreatitis. Short-term stent placement in the
dorsal duct, with or without papillotomy of the minor papilla, is a promising approach
in patients with symptomatic pancreas divisum, particularly if it is associated with
acute recurrent pancreatitis. Endoscopic treatment of chronic obstructive pancreatitis
is technically effective and safe, but the indication remains controversial, mainly
due to a lack of controlled trials. Endoscopic transmural drainage of pancreatic pseudocysts
or abscesses is very effective, and should be considered as a primary approach in
symptomatic patients. The endoscopic ultrasonography-guided technique extends the
options for obtaining access to fluid collections in difficult locations, and may
further increase the safety of the procedure. Many of these procedures are technically
demanding, and should be restricted to high-volume centers; there is a continuing
need for further evaluation and comparison with alternative strategies.
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H. Neuhaus, M.D.
Dept. of Internal Medicine · Evangelisches Krankenhaus Düsseldorf
Kirchfeldstrasse 40 · 40217 Düsseldorf · Germany
Fax: + 49-211-919-3960
eMail: medizinischeklinik@evk-duesseldorf.de
