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ERCP in Chronic Pancreatitis

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ERCP and EUS

Abstract

Chronic pancreatitis (CP) is a morbid disease found commonly in the Indian subcontinent and across the world. Predominant pathologies observed in CP are pancreatic stones with or without pancreatic duct strictures which may be dominant or multiple. Pseudocyst formation and ascites with or without pleural effusion may be seen with pancreatic duct disruptions. Some patients may have an essentially small duct disease with parenchymal atrophy without stones or significant strictures. Patients with chronic pancreatitis most commonly manifest with abdominal pain, steatorrhoea, diabetes mellitus, and weight loss. Jaundice is seen with associated bile duct stenosis. The exact etiology and pathogenesis of CP remain unknown and various environmental, nutritional, and genetic factors are considered responsible. Treatment strategies for chronic pancreatitis are medical, endoscopic, or surgical. Short- and long-term outcomes of these procedures are well studied in various studies.

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Correspondence to Suryaprakash R. Bhandari MS, DNB, FCPS .

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Video Captions

Video 13.1 Endotherapy for radio-lucent pancreatic duct calculi

Pancreatogram showing hugely dilated (sigmoid type) pancreatic duct through the tail containing multiple large radio-lucent calculi. Pancreatic sphincterotomy done. The pancreatic duct orifice was further dilated using a CRE balloon (Boston Scientific, Marlborough, MA) up to 12 mm. Multiple radiolucent calculi extracted using a stone extraction balloon. Temporary 7 Fr stent placed in the pancreatic duct.

Video 13.2 Endotherapy for radio-opaque pancreatic duct stones

Pancreatogram showing dilated irregular duct through the tail containing multiple pulverized calculi following ESWL. Pancreatic sphincterotomy done. Pulverized calculi were then extracted using a stone extraction balloon. Temporary stent placed in the pancreatic duct (not shown), and patient was asked to follow up 3 months later for repeat ERCP.

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Maydeo, A., Bhandari, S., Bapat, M. (2015). ERCP in Chronic Pancreatitis. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_13

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  • DOI: https://doi.org/10.1007/978-1-4939-2320-5_13

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