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ERCP in Patients with Chronic Pancreatitis

  • Virendra JoshiEmail author
  • Laura Alder
Chapter

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.

Keywords

Chronic pancreatitis Stenting Sphincterotomy Dilation Pseudocyst Stricture Acute recurrent pancreatitis Pancreas divisum 

Supplementary material

Video 3.1

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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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Tulane School of MedicineNew OrleansUSA
  2. 2.University of Queensland School of MedicineBrisbaneAustralia
  3. 3.Department of Gastroenterology, Advanced Endoscopy, Ochsner Medical CenterOchsner Cancer InstituteNew OrleansUSA
  4. 4.Mayne Medical SchoolUniversity of Queensland School of MedicineBrisbaneAustralia

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