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ERCP in Patients with Chronic Pancreatitis

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Advanced Pancreaticobiliary Endoscopy

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Abstract

Chronic pancreatitis (CP) is a process characterized by inflammatory destruction of pancreatic parenchyma and ductal structures with formation of fibrosis. Patients complain of pain as the predominant symptom of CP. Treatment is directed towards symptoms and management of the structural complications—stones, pancreatic ductal strictures, duct leaks, pseudocysts, and associated biliary strictures. Medical therapies such as abstinence from alcohol, dietary alterations, analgesics, oral enzyme supplements, and somatostatin analogs are only partially effective in relieving pain. Endoscopic therapy for CP was introduced more than 15 years ago. Endoscopic therapy as first line therapy may reduce or eliminate the need for surgical procedures, may serve as a bridge to surgery and can predict the response to surgical therapy. If endoscopic therapy is unsuccessful, surgical therapy is still an option for most patients. The aim of endoscopic therapy in patients with CP is to alleviate outflow obstruction of the biliary or pancreatic secretions. Endoscopic therapy using Endoscopic Retrograde Cholangiography (ERCP) should be considered in conjunction with medical, surgical, and percutaneous approaches. This chapter reviews the current role of ERCP in management of chronic pancreatitis.

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Authors and Affiliations

  1. Tulane School of Medicine, New Orleans, LA, USA

    Virendra Joshi M.D., A.G.A.F.

  2. University of Queensland School of Medicine, Brisbane, QLD, Australia

    Virendra Joshi M.D., A.G.A.F.

  3. Department of Gastroenterology, Advanced Endoscopy, Ochsner Medical Center, Ochsner Cancer Institute, 1514, Jefferson Hwy, New Orleans, LA, 70121, USA

    Virendra Joshi M.D., A.G.A.F. & Laura Alder

  4. Mayne Medical School, University of Queensland School of Medicine, Brisbane, QLD, Australia

    Laura Alder

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  1. Virendra Joshi M.D., A.G.A.F.
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Correspondence to Virendra Joshi M.D., A.G.A.F. .

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  1. Salt Lake City, Utah, USA

    Douglas G. Adler

Video Legend

Demonstrating key procedures in management of chronic pancreatitis. Pancreatic and biliary cannulation, sphincterotomy, stenting and dilation, drainage of pancreatic fluid collections. (65,945 kb)

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Joshi, V., Alder, L. (2016). ERCP in Patients with Chronic Pancreatitis. In: Adler, D. (eds) Advanced Pancreaticobiliary Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-26854-5_3

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