Chronic pancreatitis

Abstract

Endoscopic therapy is considered as the first-line modality in the management of main pancreatic duct (MPD) and common bile duct (CBD) obstruction in the setting of painful chronic pancreatitis. Decompression of the MPD can be achieved by pancreatic sphincterotomy, temporary stent(s) placement, and pancreatic stone(s) extraction, usually after fragmentation with extracorporeal shock waves lithotripsy or by the challenging EUS-guided MPD drainage for patients in whom conventional ERCP failed. Biliary obstruction can be relieved by temporary multiple plastic stents or fully covered metal stent insertion. Clinical results include adequate pain relief for about two-thirds of patients and long-term resolution of CBD obstruction. Patients should be selected for primary endoscopic management taking into account the factors associated with a good long-term outcome, and available either at work-up or after treatment.