Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Gastroenterology
Published in: Journal of Gastroenterology 2/2016

01-02-2016 | Special Article

Evidence-based clinical practice guidelines for chronic pancreatitis 2015

Authors: Tetsuhide Ito, Hiroshi Ishiguro, Hirotaka Ohara, Terumi Kamisawa, Junichi Sakagami, Naohiro Sata, Yoshifumi Takeyama, Morihisa Hirota, Hiroyuki Miyakawa, Hisato Igarashi, Lingaku Lee, Takashi Fujiyama, Masayuki Hijioka, Keijiro Ueda, Yuichi Tachibana, Yoshio Sogame, Hiroaki Yasuda, Ryusuke Kato, Keisho Kataoka, Keiko Shiratori, Masanori Sugiyama, Kazuichi Okazaki, Shigeyuki Kawa, Yusuke Tando, Yoshikazu Kinoshita, Mamoru Watanabe, Tooru Shimosegawa

Published in: Journal of Gastroenterology | Issue 2/2016

Login to get access

Abstract

Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.
Appendix
Available only for authorised users
Literature
1.
Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol. 2010;45:584–91.CrossRefPubMed
2.
Schünemann HJ, Oxman AD, Brozek J, et al. GRADE: assessing the quality of evidence for diagnostic recommendations. Evid Based Med. 2008;13:162–3.CrossRefPubMed
3.
Schünemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:1106–10.PubMedCentralCrossRefPubMed
4.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.PubMedCentralCrossRefPubMed
5.
Pezzilli R, Talamini G, Gullo L. Behavior of serum pancreatic enzymes in chronic pancreatitis. Dig Liver Dis. 2000;32:233–7.CrossRefPubMed
6.
Ventrucci M, Gullo L, Daniele C, et al. Comparative study of serum pancreatic isoamylase, lipase, and trypsin-like immunoreactivity in pancreatic disease. Digestion. 1983;28:114–21.CrossRefPubMed
7.
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.PubMed
8.
Buscail L, Escourrou J, Moreau J, et al. Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with 8 conventional ultrasonography, computed tomography, and ERCP. Pancreas. 1995;10:251–7.CrossRefPubMed
9.
Rosch T, Schusdziarra V, Born P, et al. Modern imaging methods versus clinical assessment in the evaluation of hospital in-patients with suspected pancreatic disease. Am J Gastroenterol. 2000;95:2261–70.CrossRefPubMed
10.
Bozkurt T, Braun U, Leferink S, et al. Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis. Gut. 1994;35:1132–6.PubMedCentralCrossRefPubMed
11.
Sanyal R, Stevens T, Novak E, et al. Secretin-enhanced MRCP: review of technique and application with proposal for quantification of exocrine function. AJR Am J Roentgenol. 2012;198:124–32.CrossRefPubMed
12.
Catalano MF, Lahoti S, Geenen JE, et al. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc. 1998;48:11–7.CrossRefPubMed
13.
Wiersema MJ, Hawes RH, Lehman GA, et al. Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin. Endoscopy. 1993;25:555–64.CrossRefPubMed
14.
Buscail L, Escourrou J, Moreau J, et al. Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP. Pancreas. 1995;10:251–7.CrossRefPubMed
15.
Mikata R, Ishihara T, Tada M, et al. Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer. J Gastroenterol. 2013;48:866–73.CrossRefPubMed
16.
Kataoka K, Yamane Y, Kato M, et al. Diagnosis of chronic pancreatitis using noninvasive tests of exocrine pancreatic function: comparison to duodenal intubation tests. Pancreas. 1997;15:409–15.CrossRefPubMed
17.
Stasi MD, Lencioni R, Solmi L, et al. Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study. Am J Gastroenterol. 1998;93:1329–33.CrossRefPubMed
18.
Tanno S, Nakano Y, Koizumi K, et al. Pancreatic ductal adenocarcinomas in long-term follow-up patients with branch duct intraductal papillary mucinous neoplasms. Pancreas. 2010;39:36–40.CrossRefPubMed
19.
Ellis I, Lerch MM, Whitcomb DC. Genetic testing for hereditary pancreatitis: guideline for indication, counseling, consent and privacy issues. Pancreatology. 2001;1:405–15.CrossRefPubMed
20.
Teich N, Mossner J. Hereditary chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2008;22:115–30.CrossRefPubMed
21.
Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas. 1997;14:215–21.CrossRefPubMed
22.
Ramesh H. Proposal for a new grading system for chronic pancreatitis. J Clin Gastroenterol. 2002;35:67–70.CrossRefPubMed
23.
Ventrucci M, Gullo L, Daniele C, et al. Comparative study of serum pancreatic isoamylase, lipase, and trypsin-like immunoreactivity in pancreatic disease. Digestion. 1983;28:114–21.CrossRefPubMed
24.
Kamisawa T, Matsukawa M, Yoshiike M, et al. Chronic pancreatitis progressing from segmental lesions. Hepatogastroenterology. 2005;52:1255–8.PubMed
25.
Otsuki M. Chronic pancreatitis: the problems of diagnostic criteria. Pancreatology. 2004;4:28–41.CrossRefPubMed
26.
Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–61.CrossRefPubMed
27.
Kitagawa M, Naruse S, Ishiguro H, et al. Evaluating exocrine function tests for diagnosing chronic pancreatitis. Pancreas. 1997;15:402–8.CrossRefPubMed
28.
Kataoka K, Yamane Y, Kato M, et al. Diagnosis of chronic pancreatitis using noninvasive tests of exocrine pancreatic function: comparison to duodenal intubation tests. Pancreas. 1997;15:409–15.CrossRefPubMed
29.
Hayakawa T, Kondo T, Shibata T. Relationship between pancreatic exocrine function and histological changes in chronic pancreatitis. Am J Gastroenterol. 1992;87:1170–4.PubMed
30.
31.
Chari ST, Singer MV. The problem of classification and staging of chronic pancreatitis. Scand J Gastroenterol. 1994;29:949–60.CrossRefPubMed
32.
Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007;42:101–19.CrossRefPubMed
33.
Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120:682–707.CrossRefPubMed
34.
35.
Ammann RW. Diagnosis and management of chronic pancreatitis: current knowledge. Swiss Med Wkly. 2006;136:166–74.PubMed
36.
Nakamura T, Takeuchi T, Tando Y. Pancreatic dysfunction and treatment options. Pancreas. 1998;16:329–36.CrossRefPubMed
37.
Marotta F, O’Keefe SJ, Marks IN, et al. Pancreatic enzyme replacement therapy: importance of gastric acid secretion, H2-antagonists, and enteric coating. Dig Dis Sci. 1989;34:456–61.CrossRefPubMed
38.
Lankisch PG. Enzyme treatment of exocrine pancreatic insufficiency in chronic pancreatitis. Digestion. 1993;54(Suppl 2):21–9.CrossRefPubMed
39.
Layer P, Keller J, Lankisch PG. Pancreatic enzyme replacement therapy. Curr Gastroenterol Rep. 2001;3:101–8.CrossRefPubMed
40.
Nakamura T, Arai Y, Tando Y, et al. Effect of omeprazole on changes in gastric and upper small intestine pH levels in patients with chronic pancreatitis. Clin Ther. 1995;17:448–59.CrossRefPubMed
41.
42.
Scolapio JS, Malhi-Chowla N, Ukleja A. Nutrition supplementation in patients with acute and chronic pancreatitis. Gastroenterol Clin North Am. 1999;28:695–707.CrossRefPubMed
43.
Perry RS, Gallagher J. Management of maldigestion associated with pancreatic insufficiency. Clin Pharm. 1985;4:161–9.PubMed
44.
Kawabe K, Ito T, Igarashi H, et al. The current managements of pancreatic diabetes in Japan. Clin J Gastroenterol. 2009;2:1–8.CrossRefPubMed
45.
Ito T, Otsuki M, Igarashi H, et al. Epidemiological study of pancreatic diabetes in Japan in 2005: a nationwide study. Pancreas. 2010;39:829–35.CrossRefPubMed
46.
Daniel JD, Michael AN. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006;368:1969–75.
47.
Elashoff M, Matveyenko AV, Gier B, et al. Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies. Gastroenterology. 2011;141:150–6.PubMedCentralCrossRefPubMed
48.
Butler PC, Elashoff M, Elahoff R, et al. A critical analysis of the clinical use of incretin-based therapies: are the GLP-1 therapies safe? Diabetes Care. 2013;36:2118–25.PubMedCentralCrossRefPubMed
49.
Dore DD, Hussein M, Hoffman C, et al. A pooled analysis of exenatide use and risk of acute pancreatitis. Curr Med Res Opin. 2013;29:1577–86.CrossRefPubMed
50.
Nauck MA. A critical analysis of the clinical use of incretin-based therapies: the benefits by far outweigh the potential risks. Diabetes Care. 2013;36:2126–32.PubMedCentralCrossRefPubMed
51.
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.CrossRefPubMed
52.
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.CrossRefPubMed
53.
Nealon WH, Walser E. Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Ann Surg. 2003;237:614–20.PubMedCentralPubMed
54.
Schlosser W, Siech M, Beger HG. Pseudocyst treatment in chronic pancreatitis: surgical treatment of the underlying disease increases the long-term success. Dig Surg. 2005;22:340–5.CrossRefPubMed
55.
Olakowski M, Mieczkowska-Palacz H, Olakowska E, et al. Surgical management of pancreaticopleural fistulas. Acta Chir Belg. 2009;109:735–40.PubMed
56.
Tajima Y, Tsutsumi R, Kuroki T, et al. Evaluation and management of thoracopancreatic fistula. Surgery. 2006;140:773–8.CrossRefPubMed
57.
Ohge H, Yokoyama T, Kodama T, et al. Surgical approaches for pancreatic ascites: report of three cases. Surg Today. 1999;29:458–61.CrossRefPubMed
58.
Dumonceau JM, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2012;44:277–89.CrossRefPubMed
59.
Lermite E, Regenet N, Tuech JJ, et al. Diagnosis and treatment of hemosuccus pancreaticus: development of endovascular management. Pancreas. 2007;34:229–32.CrossRefPubMed
60.
Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy. Pancreas. 2005;30:26–30.PubMed
61.
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.PubMed
62.
Sauerbruch T, Holl J, Paumgartner G. Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study. Gut. 1992;33:969–72.PubMedCentralCrossRefPubMed
63.
Hayakawa T, Kondo T, Shibata T, et al. Chronic alcoholism and evolution of pain and prognosis in chronic pancreatitis. Digestion. 1993;54:148–55.CrossRef
64.
Lankisch PG, Lohr-Happe A, Otto J, et al. Natural course in chronic pancreatitis. Digestion. 1993;54:148–55.CrossRefPubMed
65.
Miyake H, Harada H, Kunichika K, et al. Clinical course and prognosis of chronic pancreatitis. Pancreas. 1987;2:378–85.CrossRefPubMed
66.
Andriulli A, Botteri E, Almasio PL, et al. Smoking as a cofactor for causation of chronic pancreatitis: a meta-analysis. Pancreas. 2010;39:1205–10.CrossRefPubMed
67.
Cavallini G, Talamini G, Vaona B, et al. Effect of alcohol and smoking on pancreatic lithogenesis in the course of chronic pancreatitis. Pancreas. 1994;9:42–6.CrossRefPubMed
68.
Imoto M, DiMagno EP. Cigarette smoking increases the risk of pancreatic calcification in late-onset but not early-onset idiopathic chronic pancreatitis. Pancreas. 2000;21:115–9.CrossRefPubMed
69.
Kanoh M, Ibata H, Miyagawa M, et al. Clinical effects of camostat in chronic pancreatitis. Biomed Res. 1989;10(Suppl 1):145–50.
70.
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.CrossRefPubMed
71.
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.CrossRefPubMed
72.
Kataoka K, Sakagami J, Hirota M, et al. Effects of oral ingestion of the elemental diet in patients with painful chronic pancreatitis in the real-life setting in Japan. Pancreas. 2014;43:451–7.CrossRefPubMed
73.
Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer: international Pancreatitis Study Group. N Engl J Med. 1993;328:1433–7.CrossRefPubMed
74.
Kamisawa T, Tu Y, Egawa N, et al. The incidence of pancreatic and extrapancreatic cancers in Japanese patients with chronic pancreatitis. Hepatogastroenterology. 2007;54:1579–81.PubMed
75.
Capurso G, Falconi M, Panzuto F, et al. Risk factors for sporadic pancreatic endocrine tumors: a case-control study of prospectively evaluated patients. Am J Gastroenterol. 2009;104:3034–304.CrossRefPubMed
76.
Lankisch MR, Imoto M, Layer P, et al. The effect of small amounts of alcohol on the clinical course of chronic pancreatitis. Mayo Clin Proc. 2001;76:242–51.CrossRefPubMed
77.
Arvanitakis M, Van Laethem JL, Parma J, et al. Predictive factors for pancreatic cancer in patients with chronic pancreatitis in association with K-ras gene mutation. Endoscopy. 2004;36:535–42.CrossRefPubMed
78.
Löhr M, Müller P, Mora J, et al. p53 and K-ras mutations in pancreatic juice samples from patients with chronic pancreatitis. Gastrointest Endosc. 2001;53:734–43.CrossRefPubMed
79.
Nojgaard C, Bendtsen F, Becker U, et al. Danish patients with chronic pancreatitis have a four-fold higher mortality rate than the Danish population. Clin Gastroenterol Hepatol. 2010;8:384–90.CrossRefPubMed
80.
Lankisch PG, Löhr-Happe A, Otto J, et al. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148–55.CrossRefPubMed
81.
Knop FK, Vilsboll T, Larsen S, et al. No hypoglycemia after subcutaneous administration of glucagon-like peptide-1 in lean type 2 diabetic patients and in patients with diabetes secondary to chronic pancreatitis. Diabetes Care. 2003;26:2581–7.CrossRefPubMed
Metadata
Title
Evidence-based clinical practice guidelines for chronic pancreatitis 2015
Authors
Tetsuhide Ito
Hiroshi Ishiguro
Hirotaka Ohara
Terumi Kamisawa
Junichi Sakagami
Naohiro Sata
Yoshifumi Takeyama
Morihisa Hirota
Hiroyuki Miyakawa
Hisato Igarashi
Lingaku Lee
Takashi Fujiyama
Masayuki Hijioka
Keijiro Ueda
Yuichi Tachibana
Yoshio Sogame
Hiroaki Yasuda
Ryusuke Kato
Keisho Kataoka
Keiko Shiratori
Masanori Sugiyama
Kazuichi Okazaki
Shigeyuki Kawa
Yusuke Tando
Yoshikazu Kinoshita
Mamoru Watanabe
Tooru Shimosegawa
Publication date
01-02-2016
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 2/2016
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-015-1149-x

Other articles of this Issue 2/2016

Journal of Gastroenterology 2/2016 Go to the issue

Original Article—Liver, Pancreas, and Biliary Tract

Kupffer phase image of Sonazoid-enhanced US is useful in predicting a hypervascularization of non-hypervascular hypointense hepatic lesions detected on Gd-EOB-DTPA-enhanced MRI: a multicenter retrospective study

Original Article—Liver, Pancreas, and Biliary Tract

Evaluation of inflammation-based prognostic scores in patients undergoing hepatobiliary resection for perihilar cholangiocarcinoma

Original Article—Alimentary Tract

Identification of differentially expressed signatures of long non-coding RNAs associated with different metastatic potentials in gastric cancer

Original Article—Alimentary Tract

pH Impedance vs. traditional pH monitoring in clinical practice: an outcome study

Letter to the Editor

Reply to the letter by Kawada entitled ‘‘Combined effect of proton-pump inhibitors and other drugs with regard to lower gastrointestinal tract bleeding with special reference to low-dose aspirin’’

Review

Role of gastrointestinal hormones in feeding behavior and obesity treatment
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits