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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2012; 03(S 05): 048-052
DOI: 10.4103/0976-5042.95032
Review Article
Society of Gastrointestinal Endoscopy of India

Management of chronic pancreatitis: Role of endoscopic therapy

Manu Tandan
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
,
D. Nageshwar Reddy
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
› Author Affiliations
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Publication History

Publication Date:
26 September 2019 (online)

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Abstract

Chronic pancreatitis (CP), a disease of varied etiology can, from the endoscopists perspective present as ductal strictures, stones, ductal leaks and fluid collections, biliary strictures or duodenal narrowing. This article deals with role of ERCP in the management of CP associated strictures and calculi. ERCP has a limited role in the diagnosis CP, though we feel that it is better at identifying small ductal calculi or leaks as compared to MRCP. Major and minor papilla sphincterotomy gives relief from pain in patients with mild or moderate ductal changes. Pancreatic ductal strictures are best managed by stenting. Use of multiple plastic stents (8.5-11Fr diameter) gives relief from pain in 84% and strictures resolution in 95% on follow up of over 3 years. CP associated CBD strictures are also managed by placement of multiple stents. Covered SEMS are increasingly being used in these strictures. Surgery is often the best option for CP associated CBD strictures which recur after adequate endotherapy. ESWL is the standard of therapy for pancreatic ductal calculi which are large, as seen in the tropics and the non alcoholic form of CP. Our experience has shown complete or partial clearance with ESWL in over 90% of patients with large PD calculi. Good pain relief was seen in both on short and long term follow up. In selected patients of CP, ERCP and endotherapy should be offered as first line of treatment, as the results are comparable to surgery. Prior endotherapy also does not interfere with subsequent surgical procedures.

Key words

Chronic pancreatitis - endoscopic pancreatic sphincterotomy - minor papilla sphincterotomy
 

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