Endoscopic Management of Chronic Pancreatitis

  • Boon Eu Andrew Kwek
  • Tiing Leong Ang
  • Amit Maydeo
Chapter

Abstract

Chronic pancreatitis has various morphological complications arising from inflammation and fibrosis. When symptoms arise, they may be alleviated by endoscopic therapy directed against pancreatic ductal stones, pancreatic or biliary strictures, and pseudocysts. Patients with refractory pain may be palliated by celiac plexus block via the endosonography-guided approach. Here, we present the role of endoscopy in the management of chronic pancreatitis, taking into account comparative and alternative approaches.

Keywords

Chronic pancreatitis Endoscopic treatment 

References

  1. Abdallah AA, Krige JE, Bornman PC. Biliary tract obstruction in chronic pancreatitis. HPB (Oxford). 2007;9:421–8.CrossRefGoogle Scholar
  2. Adler DG, Lichtenstein D, Baron TH, et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006;63:933–7.CrossRefPubMedGoogle Scholar
  3. Ammann RW, Muench R, Otto R, et al. Evolution and regression of pancreatic calcification in chronic pancreatitis. A prospective long-term study of 107 patients. Gastroenterology. 1988;95:1018–28.CrossRefPubMedGoogle Scholar
  4. Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part I: classification, pathophysiology, anatomic considerations and treatment. JOP. 2004a;5:8–24.PubMedGoogle Scholar
  5. Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part II: natural history. JOP. 2004b;5:64–70.PubMedGoogle Scholar
  6. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.CrossRefPubMedGoogle Scholar
  7. Behm B, Brock A, Clarke BW, et al. Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis. Endoscopy. 2009;41:547–51.CrossRefPubMedGoogle Scholar
  8. Binmoeller KF, Jue P, Seifert H, et al. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy. 1995;27:638–44.CrossRefPubMedGoogle Scholar
  9. Boggi U, Di Candio G, Campatelli A, Pietrabissa A, Mosca F. Nonoperative management of pancreatic pseudocysts. Problems in differential diagnosis. Int J Pancreatol. 1999;25:123–33.CrossRefPubMedGoogle Scholar
  10. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128:586–90.CrossRefPubMedGoogle Scholar
  11. Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet. 2011;377:1184–97.CrossRefPubMedGoogle Scholar
  12. Brand B, Kahl M, Sidhu S, et al. Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis. Am J Gastroenterol. 2000;95:3428–38.CrossRefPubMedGoogle Scholar
  13. Cahen D, Rauws E, Fockens P, et al. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy. 2005;37:977–83.CrossRefPubMedGoogle Scholar
  14. Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356:676–84.CrossRefPubMedGoogle Scholar
  15. Cahen DL, Rauws EA, Gouma DJ, Fockens P, Bruno MJ. Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy. 2008;40:697–700.CrossRefPubMedGoogle Scholar
  16. Cahen DL, Gouma DJ, Laramée P, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology. 2011;141:1690–5.CrossRefPubMedGoogle Scholar
  17. Costamagna G, Gabbrielli A, Mutignani M, et al. Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results. Gastrointest Endosc. 1997;46:231–6.CrossRefPubMedGoogle Scholar
  18. Costamagna G, Bulajic M, Tringali A, et al. Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results. Endoscopy. 2006;38:254–9.CrossRefPubMedGoogle Scholar
  19. Cremer M, Deviere J, Delhaye M, et al. Stenting in severe chronic pancreatitis; results of medium term follow-up in 76 patients. Endoscopy. 1991;23:171–6.CrossRefPubMedGoogle Scholar
  20. Delhaye M, Vandermeeren A, Baize M, Cremer M. Extracorporeal shockwave lithotripsy of pancreatic calculi. Gastroenterology. 1992;102:610–20.CrossRefPubMedGoogle Scholar
  21. Delhaye M, Arvanitakis M, Verset G, Cremer M, Devière J. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol. 2004;2:1096–106.Google Scholar
  22. Díte P, Ruzicka M, Zboril V, Novotný I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003;35:553–8.CrossRefPubMedGoogle Scholar
  23. Dumonceau JM, Costamagna G, Tringali A, et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut. 2007;56:545–52.CrossRefPubMedGoogle Scholar
  24. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2012;44:784–800.CrossRefPubMedGoogle Scholar
  25. Eleftherladis N, Dinu F, Delhaye M, et al. Long-term outcome after pancreatic stenting in severe chronic pancreatitis. Endoscopy. 2005;37:223–30.CrossRefPubMedGoogle Scholar
  26. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120:682–707.CrossRefPubMedGoogle Scholar
  27. Gornals JB, De la Serna-Higuera C, Sánchez-Yague A, et al. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc. 2013;27:1428–34.CrossRefPubMedGoogle Scholar
  28. Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999;94:900–5.CrossRefPubMedGoogle Scholar
  29. Gress F, Schmitt C, Sherman S, et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96:409–16.CrossRefPubMedGoogle Scholar
  30. Gumaste UV, Dave PB. Pancreatic pseudocyst drainage—the needle or the scalpel? J Clin Gastroenterol. 1991;13:500–5.CrossRefPubMedGoogle Scholar
  31. Hu LH, Ye B, Yang YG, et al. Extracorporeal shock wave lithotripsy for Chinese patients with pancreatic stones—a prospective study of 214 cases. Pancreas. 2016;45(2):298–305.Google Scholar
  32. Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy results of a multicenter survey. Pancreas. 2005;30:26–30.PubMedGoogle Scholar
  33. Itoi T, Sofuni A, Itokawa F, et al. Transpapillary incision of refractory circumscript pancreatic duct stricture using wire-guided snare forceps. World J Gastroenterol. 2010;16(12):1541–4.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Itoi T, Binmoeller KF, Shah J, et al. Clinical evaluation of a novel lumen apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75:870–6.CrossRefPubMedGoogle Scholar
  35. Kahl S, Zimmermann S, Genz I, et al. Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol. 2003;98:2448–53.CrossRefPubMedGoogle Scholar
  36. Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127–34.CrossRefPubMedGoogle Scholar
  37. Li BR, Liao Z, Du TT, et al. Risk factors for complications of pancreatic extracorporeal shock wave lithotripsy. Endoscopy. 2014;46:1092–100.CrossRefPubMedGoogle Scholar
  38. Maydeo A, Soehendra N, Reddy N, Bhandari S. Endotherapy for chronic pancreatitis with intracanalar stones. Endoscopy. 2007;39:653–8.CrossRefPubMedGoogle Scholar
  39. Moon SH, Kim MH, Park DH, et al. Modified fully covered selfexpandable metal stents with antimigration features for benign pancreatic duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc. 2010;72:86–91.CrossRefPubMedGoogle Scholar
  40. Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol. 2010;24:281–98.CrossRefPubMedGoogle Scholar
  41. Ohara H, Hoshino M, Hayakawa T, et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol. 1996;91:1388–94.PubMedGoogle Scholar
  42. Park DH, Kim MH, Moon SH, et al. Feasibility and safety of placement of a newly designed, fully covered self-expandable metal stent for refractory benign pancreatic ductal strictures: a pilot study (with video). Gastrointest Endosc. 2008;68:1182–9.CrossRefPubMedGoogle Scholar
  43. Pezizilli R, Fantini L. Chronic pancreatitis: assessing the quality of life. J Pancreas. 2005;6:406–9.Google Scholar
  44. Poley JW, Cahen DL, Metselaar HJ, et al. A prospective group sequential study evaluating a new type of fully covered self-expandable metal stent for the treatment of benign biliary strictures (with video). Gastrointest Endosc. 2012;75:783–9.CrossRefPubMedGoogle Scholar
  45. 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;54:2330–7.CrossRefPubMedGoogle Scholar
  46. Rosso E, Alexakis N, Ghaneh P, et al. Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment. Dig Surg. 2003;20:397–406.CrossRefPubMedGoogle Scholar
  47. Santosh D, Lakhtakia S, Gupta R, et al. Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis. Aliment Pharmacol Ther. 2009;29:979–84.CrossRefPubMedGoogle Scholar
  48. Sauerbruch T, Holl J, Sackmann M, Paumgartner G. Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study. Gut. 1992;33:969–72.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Sey MSL, Schmaltz L, Al-Haddad MA, et al. Effectiveness and safety of serial endoscopic ultrasound–guided celiac plexus block for chronic pancreatitis. Endosc Int Open. 2015;3:E56–9.PubMedGoogle Scholar
  50. Shah RJ, Shah JN, Waxman I, et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol. 2015;13(4):747–52.Google Scholar
  51. Sherman S, Lehman GA, Hawes RH, et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc. 1991;37:511–7.CrossRefPubMedGoogle Scholar
  52. Spivak H, Galloway JR, Amerson JR, et al. Management of pancreatic pseudocysts. J Am Coll Surg. 1998;186:507–11.CrossRefPubMedGoogle Scholar
  53. Tadenuma H, Ishihara T, Yamaguchi T, et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol. 2005;3:1128–35.Google Scholar
  54. Talreja JP, Shami VM, Ku J, et al. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc. 2008;68:1199–203.CrossRefPubMedGoogle Scholar
  55. Tandan M, Reddy DN, Santosh D, et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Indian J Gastroenterol. 2010;29:143–8.CrossRefPubMedGoogle Scholar
  56. Tandan M, Reddy DN, Talukdar R, et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc. 2013;78:726–33.CrossRefPubMedGoogle Scholar
  57. Trevino JM, Tamhane A, Varadarajulu S. Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections. J Gastroenterol Hepatol. 2010;25:526–31.CrossRefPubMedGoogle Scholar
  58. Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583–90.e1.Google Scholar
  59. Vitale GC, Reed DN, Nguyen CT, et al. Endoscopic treatment of distal bile duct stricture from chronic pancreatitis. Surg Endosc. 2000;14:227–31.CrossRefPubMedGoogle Scholar
  60. Vitale GC, Cothron K, Vitale EA, et al. Role of pancreatic duct stenting in the treatment of chronic pancreatitis. Surg Endosc. 2004;18:1431–4.CrossRefPubMedGoogle Scholar
  61. Ziebert JJ, DiSario JA. Dilation of refractory pancreatic duct strictures: the turn of the screw. Gastrointest Endosc. 1999;49:632–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2017

Authors and Affiliations

  • Boon Eu Andrew Kwek
    • 1
  • Tiing Leong Ang
    • 1
  • Amit Maydeo
    • 2
  1. 1.Department of Gastroenterology and HepatologyChangi General HospitalSingaporeSingapore
  2. 2.Baldota Institute of Digestive SciencesGlobal HospitalMumbaiIndia

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