Chronic pancreatitis: The case for surgery

Abstract

Treatment of pain in chronic pancreatitis includes medical, endoscopic and surgical therapy. Medical treatment may involve the use of analgesics, pancreatic enzymes, antioxidants and removal of risk factors. However, a substantial number of patients do not experience pain relief with medical treatment, and those with local complications cannot be treated medically indefinitely. These require endoscopic or surgical therapy. Endoscopic therapy has involved the use of a) pancreatic sphincterotomy, b) stent placement, c) nasopancreatic drainage, d) pseudocyst drainage, e) extra corporeal shock wave lithotripsy (ESWL), and f) dilatation of strictures. The current options for surgical therapy include: a) partial pancreatic resections, b) extended pancreatic drainage procedures (which involve additional subtotal resection of the head or a deep coring out of the head, or c) pure pancreatic drainage procedures. In effect surgical procedures provide a more thorough drainage of the ductal system than pancreatic stent placement. This is especially true in the complex ductal arrangement of the head of the pancreas, where simple drainage of the duct or stent placement by endoscopy is unlikely to provide thorough drainage and relief of symptoms.

Key words

Chronic pancreatitis - pancreatic resections - pancreatic drainage procedures - endoscopic therapy

• References

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