Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Ultrasound-Guided Management of Chronic Pancreatitis

  • Pancreas and Biliary Tract (O Haluszka and H Gavini, Section Editors)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to discuss the role of endoscopic ultrasound (EUS) in the diagnosis and treatment of chronic pancreatitis (CP).

Recent Findings

EUS has evolved and become invaluable in diagnosing early CP with the use of elastography and contrast enhancement. Lumen-apposing metal stents have allowed for easier transmural drainage and necrosectomy for pancreatic pseudocyst and walled of necrosis. EUS-guided pancreatic duct drainage is being utilized for pancreatic duct complications including stenosis, stones, and duct disruptions that are not amendable to endoscopic retrograde cholangiopancreatography.

Summary

EUS is an effective tool that assists with the diagnosis and treatment of CP. The technology continues to evolve allowing for diagnosis of CP in earlier stages, which enables more effective therapy. The development of new EUS-guided tools and techniques has improved the treatment of complications from CP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332(22):1482–90.

    Article  CAS  PubMed  Google Scholar 

  2. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120(3):682–707.

    Article  CAS  PubMed  Google Scholar 

  3. Forsmark CE. Management of chronic pancreatitis. Gastroenterology. 2013;144(6):1282–91 e3.

    Article  PubMed  Google Scholar 

  4. Gardner TB, Levy MJ. EUS diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71(7):1280–9.

    Article  PubMed  Google Scholar 

  5. Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060.

    Article  PubMed  Google Scholar 

  6. • Issa Y, Kempeneers MA, van Santvoort HC, Bollen TL, Bipat S, Boermeester MA. Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis. Eur Radiol. 2017;27(9):3820–44 A large meta-analysis demonstrating EUS as a superior imaging modality compared to MRI, CT, and US.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55(4):507–11.

    Article  PubMed  Google Scholar 

  8. Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69(7):1251–61.

    Article  PubMed  Google Scholar 

  9. Arcidiacono PG. Endoscopic ultrasound elastography. Gastroenterol Hepatol (N Y). 2012;8(1):48–67.

    Google Scholar 

  10. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139(4):1172–80.

    Article  PubMed  Google Scholar 

  11. •• Carrara S, Di Leo M, Grizzi F, Correale L, Rahal D, Anderloni A, et al. EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions. Gastrointest Endosc. 2018;87(6):1464–73 A prospective study that demonstrates how quantitative elastography can differentiate between benign and malignant lesions.

    Article  PubMed  Google Scholar 

  12. • Pozzi R, Parzanese I, Baccarin A, Giunta M, Conti CB, Cantu P, et al. Point shear-wave elastography in chronic pancreatitis: a promising tool for staging disease severity. Pancreatology. 2017;17(6):905–10 A study demonstrating that patients with chronic pancreatitis have higher pancreatic stiffness scores on elastography compared to healthy subjects.

    Article  PubMed  Google Scholar 

  13. Kuwahara T, Hirooka Y, Kawashima H, Ohno E, Sugimoto H, Hayashi D, et al. Quantitative evaluation of pancreatic tumor fibrosis using shear wave elastography. Pancreatology. 2016;16(6):1063–8.

    Article  PubMed  Google Scholar 

  14. Yip HC, Teoh AY, Chong CC, Lau JY. Current status and future applications of contrast-enhanced endoscopic ultrasonography. World J Gastrointest Endosc. 2014;6(4):121–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dietrich CF, Sharma M, Hocke M. Contrast-enhanced endoscopic ultrasound. Endosc Ultrasound. 2012;1(3):130–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harmsen FR, Domagk D, Dietrich CF, Hocke M. Discriminating chronic pancreatitis from pancreatic cancer: contrast-enhanced EUS and multidetector computed tomography in direct comparison. Endosc Ultrasound. 2018;7(6):395–403.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Iordache S, Costache MI, Popescu CF, Streba CT, Cazacu S, Saftoiu A. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA. Med Ultrason. 2016;18(1):18–24.

    Article  PubMed  Google Scholar 

  18. Kwon RS, Scheiman JM. EUS and pancreatic cyst fluid analysis: is the juice worth the aqueeze? J Gastrointest Oncol. 2011;2(4):199–202.

    PubMed  PubMed Central  Google Scholar 

  19. Khashab MA, Kim K, Lennon AM, Shin EJ, Tignor AS, Amateau SK, et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. Pancreas. 2013;42(4):717–21.

    Article  PubMed  Google Scholar 

  20. • Yang D, Samarasena JB, Jamil LH, Chang KJ, Lee D, Ona MA, et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endosc Int Open. 2018;6(12):E1423–E30 A multicenter study that shows how through-the-needle-biopsies increased diagnostic yields of pancreatic cysts.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Krishna SG, Hart PA, Malli A, Kruger A, McCarthy ST, El-Dika S, et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. Clin Gastroenterol Hepatol. 2019.

  22. Elmunzer BJ. Endoscopic drainage of pancreatic fluid collections. Clin Gastroenterol Hepatol. 2018;16(12):1851–63 e3.

    Article  PubMed  Google Scholar 

  23. • Szako L, Matrai P, Hegyi P, Pecsi D, Gyongyi Z, Csupor D, et al. Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: meta-analysis. Pancreatology. 2019; A large systematic review and meta-analysis which showed higher rates of clinical success of EUS guided transmural drainage of pancreatic fluid collections when compared to percutaneous routes, but similar rates when compared to surgery.

  24. Farias GFA, Bernardo WM, De Moura DTH, Guedes HG, Brunaldi VO, Visconti TAC, et al. Endoscopic versus surgical treatment for pancreatic pseudocysts: systematic review and meta-analysis. Medicine (Baltimore). 2019;98(8):e14255.

    Article  PubMed Central  Google Scholar 

  25. Vila JJ, Carral D, Fernandez-Urien I. Pancreatic pseudocyst drainage guided by endoscopic ultrasound. World J Gastrointest Endosc. 2010;2(6):193–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Voermans RP, Fockens P. Endoscopic transluminal drainage of walled-off necrosis: does size matter? Gastrointest Endosc. 2016;83(4):708–10.

    Article  PubMed  Google Scholar 

  27. Siddiqui AA, Kowalski TE, Loren DE, Khalid A, Soomro A, Mazhar SM, et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc. 2017;85(4):758–65.

    Article  PubMed  Google Scholar 

  28. •• Bang JY, Navaneethan U, Hasan MK, Sutton B, Hawes R, Varadarajulu S. Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut. 2018; A randomized clinical trial comparing plastic stents to LAMS in walled of necrosis. No difference is noted in amount of procedures required for clinical success and adverse effects.

  29. Dalsania R, Willingham FF. Treatment of walled-off pancreatic necrosis. Curr Opin Gastroenterol. 2019;35(5):478–82.

    Article  PubMed  Google Scholar 

  30. Kwon CI, Cho JH, Choi SH, Ko KH, Tirkes T, Gromski MA, et al. Recent advances in the diagnosis and management of chronic pancreatitis. Korean J Intern Med. 2019;34(2):242–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Penman ID, Rosch T, Group EUSW. EUS 2008 Working Group document: evaluation of EUS-guided celiac plexus neurolysis/block (with video). Gastrointest Endosc. 2009;69(2 Suppl):S28–31.

    Article  PubMed  Google Scholar 

  32. Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96(2):409–16.

    Article  CAS  PubMed  Google Scholar 

  33. Yasuda I, Wang HP. Endoscopic ultrasound-guided celiac plexus block and neurolysis. Dig Endosc. 2017;29(4):455–62.

    Article  PubMed  Google Scholar 

  34. Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci. 2009;54(11):2330–7.

    Article  PubMed  Google Scholar 

  35. Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am J Gastroenterol. 2008;103(1):98–103.

    Article  PubMed  Google Scholar 

  36. •• Levy MJ, Gleeson FC, Topazian MD, Fujii-Lau LL, Enders FT, Larson JJ, et al. Combined celiac ganglia and plexus neurolysis shortens survival, without benefit, vs plexus neurolysis alone. Clin Gastroenterol Hepatol. 2019;17(4):728–38.e9 A randomized clinical trial demonstrating poor long-term outcomes for EUS-CGN.

    Article  PubMed  Google Scholar 

  37. Jin ZD, Wang L, Li Z. Endoscopic ultrasound-guided celiac ganglion radiofrequency ablation for pain control in pancreatic carcinoma. Dig Endosc. 2015;27(1):163–4.

    Article  PubMed  Google Scholar 

  38. Bang JY, Sutton B, Hawes RH, Varadarajulu S. EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer: a randomized controlled trial (with videos). Gastrointest Endosc. 2019;89(1):58–66 e3.

    Article  PubMed  Google Scholar 

  39. Tessier G, Bories E, Arvanitakis M, Hittelet A, Pesenti C, Le Moine O, et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc. 2007;65(2):233–41.

    Article  PubMed  Google Scholar 

  40. Chapman CG, Waxman I, Siddiqui UD. Endoscopic ultrasound (EUS)-guided pancreatic duct drainage: the basics of when and how to perform EUS-guided pancreatic duct interventions. Clin Endosc. 2016;49(2):161–7.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Giovannini M. Endoscopic ultrasound-guided pancreatic duct drainage: ready for the prime time? Endosc Ultrasound. 2017;6(5):281–4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Krafft MR, Nasr JY. Anterograde endoscopic ultrasound-guided pancreatic duct drainage: a technical review. Dig Dis Sci. 2019;64(7):1770–81.

    Article  PubMed  Google Scholar 

  43. Nakai Y, Kogure H, Isayama H, Koike K. Endoscopic ultrasound-guided pancreatic duct drainage. Saudi J Gastroenterol. 2019;25(4):210–7.

    Article  PubMed  PubMed Central  Google Scholar 

  44. James TW, Baron TH. Antegrade pancreatoscopy via EUS-guided pancreaticogastrostomy allows removal of obstructive pancreatic duct stones. Endosc Int Open. 2018;6(6):E735–E8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Raj Dalsania, Rushikesh Shah & Saurabh Chawla

  2. Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Surinder Rana

Authors
  1. Raj Dalsania
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rushikesh Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Surinder Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saurabh Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Raj Dalsania or Saurabh Chawla.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pancreas and Biliary Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dalsania, R., Shah, R., Rana, S. et al. Endoscopic Ultrasound-Guided Management of Chronic Pancreatitis. Curr Gastroenterol Rep 22, 34 (2020). https://doi.org/10.1007/s11894-020-00772-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-020-00772-4

Keywords

Search

Navigation