Endoscopic Therapy in Chronic Pancreatitis

Abstract

Chronic pancreatitis, usually presenting with recurrent attacks of clinical pancreatitis or chronic pain, is usually the consequence of alcoholism [1]. Less commonly, childhood malnutrition, familial and idiopathic forms, and hyperparathyroidism are felt to be etiologic [2]. Less common still are causes such as papillary stenosis, pancreas divisum, and other obstructive etiologies. Finally, the latter occasionally occurs when chronic pancreatic duct structural damage follows a severe insult, e.g., blunt abdominal trauma or biliary pancreatitis with associated pancreatic duct (PD) disruption. Traditionally, endoscopy has been primarily utilized in conjunction with noninvasive imaging modalities for diagnosis and to direct subsequent surgical intervention [3]. More recently, a number of interventional techniques have been applied at endoscopic retrograde cholangiopancreatography (ERCP) in such patients [4]. Including PD sphincterotomy, stent or drain placement, stone extraction, and pseudocyst drainage, data are accumulating which suggest that endoscopic management is effective in a subset of patients with chronic pancreatitis (Table 1).