Endoscopy in Chronic Pancreatitis

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Chronic pancreatitis is an inflammatory process of the pancreas characterized pathologically by irreversible destruction of parenchymal and ductal architecture. Clinically, pain is the predominant symptom. Pain may be due to elevated pancreatic ductal or parenchymal pressure, and therapeutic efforts are directed at reducing pancreatic secretion or reducing pancreatic ductal or parenchymal pressure. A variety of interventions are utilized, including pharmacological therapy (pancreatic enzymes, octreotide), surgical procedures (resective, decompressive, and denervative), and endoscopic techniques. Endoscopic therapy for chronic pancreatitis has evolved over the past 15 years, with the incorporation of endoscopic techniques previously reserved for the treatment of biliary tract disorders such as bile duct stones, strictures, and leaks. Endoscopic therapy for chronic pancreatitis is highlighted in this chapter and an extensive literature review accompanies the discussion of a variety of techniques. The endoscopic techniques, safety, and clinical efficacy of the endoscopic management of pancreatic duct strictures are reviewed. Particular attention is paid to the duration of stenting, complications associated with stents, and the long-term follow-up of patients undergoing endoscopic therapy. Management of pancreatic duct stones utilizing various stone extraction techniques and the usefulness of incorporating extracorporeal shock-wave lithotripsy into the armamentarium are also discussed. The role of sphincter of Oddi dysfunction in pancreatic disease and the technique of pancreatic sphincterotomy are highlighted. The management of biliary obstruction as a complication of chronic pancreatitis is also discussed. The results of endoscopic management of pancreatic pseudocysts are briefly reviewed; however, more exhaustive discussion of the technique appears in a subsequent chapter. Endoscopic therapy of chronic pancreatitis is an expanding area for the interventional endoscopist. The appropriate selection of candidates for various pancreatic interventions is important to achieve the best results.

Original languageEnglish (US)
Title of host publicationAdvanced Digestive Endoscopy
Subtitle of host publicationERCP
PublisherBlackwell Publishing Ltd
Pages239-280
Number of pages42
ISBN (Print)9781405120791
DOIs
StatePublished - Oct 25 2007

Keywords

  • Chronic pancreatitis
  • Pancreatic duct stenting
  • Pancreatic ductal strictures
  • Pancreatic sphincterotomy
  • Pancreatic stent placement techniques

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Mchenry, L., Sherman, S., & Lehman, G. (2007). Endoscopy in Chronic Pancreatitis. In Advanced Digestive Endoscopy: ERCP (pp. 239-280). Blackwell Publishing Ltd. https://doi.org/10.1002/9780470987490.ch10