Therapeutic Pancreatic Endoscopy

Over the past decade, endoscopic retrograde cholangiopancreatography (ERCP) has developed from being a diagnostic tool to become one that is primarily used to provide therapy. This development occurred first for biliary disorders and more recently for primary diseases of the pancreas. Not only can new-generation computed tomography (CT), magnetic resonance imaging, and magnetic resonance cholangiopancreatography procedures suggest a diagnosis in the majority of individuals with pancreatic diseases today; in addition, ERCP-related complications can be minimized or avoided altogether in conjunction with positron-emission tomography or directed cytology or biopsy, either using ultrasound or CT guidance, or with tissue obtained during endoscopic ultrasonography. It is against this background that papers on therapeutic pancreatic endoscopy published during approximately the last year are reviewed here. Despite these developments, however, the following three issues concerning current advances in pancreatic endotherapy should be emphasized: firstly, most of the techniques reviewed here affect only a small number of patients; secondly, most of the techniques have been reported only by expert centers; and thirdly, most of the studies concerned have lacked control groups, and there is still a paucity of studies investigating endoscopic techniques on a randomized basis in comparison with surgery or medical therapy for the treatment of most benign and malignant pancreatic disorders.

References

• 1 Harewood G C, Wright C A, Baron T H. Impact on patient outcomes of experience in the performance of endoscopic pancreatic fluid collection drainage.  Gastrointest Endosc. 2003;  58 230-235
• 2 Baillie J. Pancreatic pseudocysts (part I).  Gastrointest Endosc. 2004;  59 8873-8879
• 3 Baillie J. Pancreatic pseudocysts (part II).  Gastrointest Endosc. 2004;  60 105-113
• 4 Hawes R H. Endoscopic management of pseudocysts.  Rev Gastroenterol Disord. 2003;  3 135-141
• 5 Giovannini M, Binmoeller K, Seifert H. Endoscopic ultrasound-guided cystgastrostomy.  Endoscopy. 2003;  35 239-245
• 6 Rosso E, Alexakis N, Ghaneh P. et al . Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment.  Dig Surg. 2003;  20 397-406
• 7 Seewald S, Brand B, Groth S. et al . Endoscopic sealing of pancreatic fistula by using N-butyl-2-cyanoacrylate.  Gastrointest Endosc. 2004;  59 463-470
• 8 Haber G. Tissue glue for pancreatic fistula.  Gastrointest Endosc. 2004;  59 535-537
• 9 Freeman M L, Guda N M. Prevention of post-ERCP pancreatitis: a comprehensive review.  Gastrointest Endosc. 2004;  59 845-864
• 10 Fazel A, Quadri A, Catalano M F. et al . Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study.  Gastrointest Endosc. 2003;  57 291-294
• 11 Dite P, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy in chronic pancreatitis.  Endoscopy. 2003;  35 553-558
• 12 Van Berkel A M, Cahen D L, van Westerloo D J. et al . Self-expanding metal stents in benign biliary strictures due to chronic pancreatitis.  Endoscopy. 2004;  36 381-384
• 13 Costamagna G, Mutignani M. Metal stents in common bile duct strictures secondary to chronic pancreatitis: a ”new” endoscopic treatment for an old problem.  Endoscopy. 2004;  36 450-452
• 14 Hirai T, Goto H, Hirooka Y. et al . Pilot study of pancreatoscopic lithotripsy using a 5-Fr instrument: selected patients may benefit.  Endoscopy. 2004;  36 212-216
• 15 Rhee J, Scheiman J, Inadomi J. ”Spontaneous” passage of a pancreatic duct stone.  Gastrointest Endosc. 2003;  57 278-280
• 16 Varadarajulu S, Noone T, Hawes R H, Cotton P B. Pancreatic duct stent insertion for functional smoldering pancreatitis.  Gastrointest Endosc. 2003;  58 438-441
• 17 Freeman M L, Overby C, Qi D. Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success.  Gastrointest Endosc. 2004;  59 8-14
• 18 Kozarek R, Hovde O, Attia F, France R. Do pancreatic duct stents cause or prevent pancreatic sepsis?.  Gastrointest Endosc. 2003;  58 505-509
• 19 Levy M J, Chari S, Adler D G. et al . Complications of temporary pancreatic stent insertion for pancreaticojejunal anastomosis during pancreaticoduodenectomy.  Gastrointest Endosc. 2004;  59 719-724
• 20 Song M H, Kim M H, Lee S K. et al . Endoscopic minor papilla interventions in patients without pancreas divisum.  Gastrointest Endosc. 2004;  59 901-905
• 21 Park S H, de Bellis M, McHenry L. et al . Use of methylene blue to identify the minor papilla or its orifice in patients with pancreas divisum.  Gastrointest Endosc. 2003;  57 358-368
• 22 Catanzaro A, Wong R CK. Endoscopic tattooing facilitates repeated localization and endoscopic therapy of a difficult-to-find minor papilla in pancreas divisum.  Gastrointest Endosc. 2004;  58 803-805
• 23 Prat F, Spieler J F, Paci S. et al . Reliability, cost-effectiveness, and safety of reuse of ancillary devices for ERCP.  Gastrointest Endosc. 2004;  60 246-252
• 24 Kozarek R A, Raltz S L, Ball T J. et al . Reuse of disposable sphincterotomes for diagnostic and therapeutic ERCP: a one year prospective study.  Gastrointest Endosc. 1999;  49 39-42
• 25 Mallery S, Matlock J, Freeman M L. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of six cases.  Gastrointest Endosc. 2004;  59 100-107
• 26 Kahaleh M, Yoshida C, Yeaton P. EUS antegrade pancreatography with gastropancreatic duct stent placement: review of two cases.  Gastrointest Endosc. 2003;  58 919-923
• 27 Chan H H, Nishioka N S, Mino M. et al . EUS-guided photodynamic therapy of the pancreas: a pilot study.  Gastrointest Endosc. 2004;  59 95-99