Top

Published in:

01-07-2017 | Review

Endoscopic Therapies for Chronic Pancreatitis

Authors: Jeffrey M. Adler, Timothy B. Gardner

Published in: Digestive Diseases and Sciences | Issue 7/2017

Abstract

Chronic pancreatitis is a fibroinflammatory disease of the pancreas leading to varying degrees of endocrine and exocrine dysfunction. Treatment options are generally designed to control the pain of chronic pancreatitis, and endoscopic therapy is one of the main treatment modalities. Herein, we describe the endoscopic management of pancreatic duct calculi and strictures, entrapment of the intrapancreatic bile duct, celiac plexus interventions, and drainage of pancreatic pseudocysts.

Yadav D, Timmons L, Benson JT, Dierkhising RA, Chari ST. Incidence, prevalence, and survival of chronic pancreatitis: A population-based study. Am J Gastroenterol. 2011;106:2192–2199. doi:10.1038/ajg.2011.328.CrossRefPubMed

Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387:1957–1966. doi:10.1016/S0140-6736(16)00097-0.CrossRefPubMed

Hall TC, Garcea G, Webb MA, Al-Leswas D, Metcalfe MS, Dennison AR. The socio-economic impact of chronic pancreatitis: A systematic review. J Eval Clin Pract. 2014;20:203–207. doi:10.1111/jep.12117.CrossRefPubMed

Spanier BW, Dijkgraaf MG, Bruno MJ. Trends and forecasts of hospital admissions for acute and chronic pancreatitis in the Netherlands. Eur J Gastroenterol Hepatol. 2008;20:653–658. doi:10.1097/MEG.0b013e3282f52f83.CrossRefPubMed

Talukdar R, Reddy DN. Pain in chronic pancreatitis: Managing beyond the pancreatic duct. World J Gastroenterol. 2013;19:6319–6328. doi:10.3748/wjg.v19.i38.6319.CrossRefPubMedPubMedCentral

Smits ME, Rauws EA, Tytgat GN, Huibregtse K. Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis. Gastrointest Endosc. 1996;43:556–560.CrossRefPubMed

Sherman S, Lehman GA, Hawes RH, et al. Pancreatic ductal stones: Frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc. 1991;37:511–517.CrossRefPubMed

Technology Committee ASGE, Adler DG, Conway JD, et al. Biliary and pancreatic stone extraction devices. Gastrointest Endosc. 2009;70:603–609. doi:10.1016/j.gie.2009.06.015.CrossRef

Kim YH, Jang SI, Rhee K, Lee DK. Endoscopic treatment of pancreatic calculi. Clin Endosc. 2014;47:227–235. doi:10.5946/ce.2014.47.3.227.CrossRefPubMedPubMedCentral

10.

Thomas M, Howell DA, Carr-Locke D, et al. Mechanical lithotripsy of pancreatic and biliary stones: Complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007;102:1896–1902.CrossRefPubMed

11.

Papachristou GI, Baron TH. Endoscopic treatment of an impacted pancreatic duct stone using a balloon catheter for electrohydraulic lithotripsy without pancreatoscopy. J Clin Gastroenterol. 2006;40:753–756.CrossRefPubMed

12.

Maydeo A, Kwek BE, Bhandari S, Bapat M, Dhir V. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). Gastrointest Endosc. 2011;74:1308–1314. doi:10.1016/j.gie.2011.08.047.CrossRefPubMed

13.

Kozarek RA, Brandabur JJ, Ball TJ, et al. Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc. 2002;56:496–500. doi:10.1067/mge.2002.128105.CrossRefPubMed

14.

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;56:545–552.CrossRefPubMed

15.

Rosch T, Daniel S, Scholz M, et al. Endoscopic treatment of chronic pancreatitis: A multicenter study of 1000 patients with long-term follow-up. Endoscopy. 2002;34:765–771. doi:10.1055/s-2002-34256.CrossRefPubMed

16.

Farnbacher MJ, Schoen C, Rabenstein T, Benninger J, Hahn EG, Schneider HT. Pancreatic duct stones in chronic pancreatitis: Criteria for treatment intensity and success. Gastrointest Endosc. 2002;56:501–506. doi:10.1067/mge.2002.128162.CrossRefPubMed

17.

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. doi:10.1055/s-0032-1309840.CrossRefPubMed

18.

Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol. 2010;24:281–298. doi:10.1016/j.bpg.2010.03.002.CrossRefPubMed

19.

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.PubMed

20.

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;91:1388–1394.PubMed

21.

Moole H, Jaeger A, Bechtold ML, Forcione D, Taneja D, Puli SR. Success of extracorporeal shock wave lithotripsy in chronic calcific pancreatitis management: A meta-analysis and systematic review. Pancreas. 2016;45:651–658. doi:10.1097/MPA.0000000000000512.CrossRefPubMed

22.

Guda NM, Freeman ML, Smith C. Role of extracorporeal shock wave lithotripsy in the treatment of pancreatic stones. Rev Gastroenterol Disord. 2005;5:73–81.PubMed

23.

Seven G, Schreiner MA, Ross AS, et al. Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc. 2012;75:997.e1–1004.e1. doi:10.1016/j.gie.2012.01.014.CrossRef

24.

Tandan M, Reddy DN, Talukdar R, et al. Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis. Gastrointest Endosc. 2013;78:726–733. doi:10.1016/j.gie.2013.05.012.CrossRefPubMed

25.

Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003;35:553–558. doi:10.1055/s-2003-40237.CrossRefPubMed

26.

Adler DG, Lichtenstein D, Baron TH, et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006;63:933–937.CrossRefPubMed

27.

Ponchon T, Bory RM, Hedelius F, et al. Endoscopic stenting for pain relief in chronic pancreatitis: Results of a standardized protocol. Gastrointest Endosc. 1995;42:452–456.CrossRefPubMed

28.

Smits ME, Badiga SM, Rauws EA, Tytgat GN, Huibregtse K. Long-term results of pancreatic stents in chronic pancreatitis. Gastrointest Endosc. 1995;42:461–467.CrossRefPubMed

29.

Weber A, Schneider J, Neu B, et al. Endoscopic stent therapy in patients with chronic pancreatitis: A 5-year follow-up study. World J Gastroenterol. 2013;19:715–720. doi:10.3748/wjg.v19.i5.715.CrossRefPubMedPubMedCentral

30.

Talukdar R, Reddy DN. Pancreatic endotherapy for chronic pancreatitis. Gastrointest Endosc Clin N Am. 2015;25:765–777. doi:10.1016/j.giec.2015.06.010.CrossRefPubMed

31.

Sauer BG, Gurka MJ, Ellen K, Shami VM, Kahaleh M. Effect of pancreatic duct stent diameter on hospitalization in chronic pancreatitis: Does size matter? Pancreas. 2009;38:728–731. doi:10.1097/MPA.0b013e3181b2bd45.CrossRefPubMed

32.

Binmoeller KF, Jue P, Seifert H, Nam WC, Izbicki J, Soehendra N. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: Long-term results. Endoscopy. 1995;27:638–644. doi:10.1055/s-2007-1005780.CrossRefPubMed

33.

Vitale GC, Cothron K, Vitale EA, et al. Role of pancreatic duct stenting in the treatment of chronic pancreatitis. Surg Endosc. 2004;18:1431–1434. doi:10.1007/s00464-003-8933-z.CrossRefPubMed

34.

Costamagna G, Bulajic M, Tringali A, et al. Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: Long-term results. Endoscopy. 2006;38:254–259. doi:10.1055/s-2005-921069.CrossRefPubMed

35.

Morgan DE, Smith JK, Hawkins K, Wilcox CM. Endoscopic stent therapy in advanced chronic pancreatitis: Relationships between ductal changes, clinical response, and stent patency. Am J Gastroenterol. 2003;98:821–826.CrossRefPubMed

36.

Moon SH, Kim MH, Park DH, et al. Modified fully covered self-expandable 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. doi:10.1016/j.gie.2010.01.063.CrossRefPubMed

37.

Andren-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part I: Classification, pathophysiology, anatomic considerations and treatment. JOP. 2004;5:8–24.PubMed

38.

Bourliere M, Sarles H. Pancreatic cysts and pseudocysts associated with acute and chronic pancreatitis. Dig Dis Sci. 1989;34:343–348.CrossRefPubMed

39.

Cheruvu CV, Clarke MG, Prentice M, Eyre-Brook IA. Conservative treatment as an option in the management of pancreatic pseudocyst. Ann R Coll Surg Engl. 2003;85:313–316. doi:10.1308/003588403769162413.CrossRefPubMedPubMedCentral

40.

Gouyon B, Levy P, Ruszniewski P, et al. Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut. 1997;41:821–825.CrossRefPubMedPubMedCentral

41.

Lerch MM, Stier A, Wahnschaffe U, Mayerle J. Pancreatic pseudocysts: Observation, endoscopic drainage, or resection? Dtsch Arztebl Int. 2009;106:614–621. doi:10.3238/arztebl.2009.0614.PubMedPubMedCentral

42.

Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583.e1–590.e1. doi:10.1053/j.gastro.2013.05.046.CrossRef

43.

Varadarajulu S, Bang JY, Phadnis MA, Christein JD, Wilcox CM. Endoscopic transmural drainage of peripancreatic fluid collections: Outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15:2080–2088. doi:10.1007/s11605-011-1621-8.CrossRefPubMed

44.

Ng PY, Rasmussen DN, Vilmann P, et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: Medium-term assessment of outcomes and complications. Endosc Ultrasound. 2013;2:199–203. doi:10.4103/2303-9027.121245.CrossRefPubMedPubMedCentral

45.

Gurusamy KS, Pallari E, Hawkins N, Pereira SP, Davidson BR. Management strategies for pancreatic pseudocysts. Cochrane Database Syst Rev. 2016;4:CD011392. doi:10.1002/14651858.CD011392.pub2.PubMed

46.

Keane MG, Sze SF, Cieplik N, et al. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: A 14-year experience from a tertiary hepatobiliary centre. Surg Endosc. 2016;30:3730–3740. doi:10.1007/s00464-015-4668-x.CrossRefPubMed

47.

Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: Long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy. 2005;37:977–983. doi:10.1055/s-2005-870336.CrossRefPubMed

48.

Bang JY, Wilcox CM, Trevino JM, et al. Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc. 2014;28:2877–2883. doi:10.1007/s00464-014-3541-7.CrossRefPubMed

49.

Arvanitakis M, Delhaye M, Bali MA, et al. Pancreatic-fluid collections: A randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc. 2007;65:609–619.CrossRefPubMed

50.

Shrode CW, Macdonough P, Gaidhane M, et al. Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: How efficacious is it? Dig Liver Dis. 2013;45:129–133. doi:10.1016/j.dld.2012.08.026.CrossRefPubMed

51.

Yang D, Amin S, Gonzalez S, et al. Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: A large multicenter study. Gastrointest Endosc. 2016;83:720–729. doi:10.1016/j.gie.2015.10.040.CrossRefPubMed

52.

Varadarajulu S, Rana SS, Bhasin DK. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am. 2013;23:863–892. doi:10.1016/j.giec.2013.06.008.CrossRefPubMed

53.

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;94:900–905.CrossRefPubMed

54.

Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: A prospective single center experience. Am J Gastroenterol. 2001;96:409–416.CrossRefPubMed

55.

Collins D, Penman I, Mishra G, Draganov P. EUS-guided celiac block and neurolysis. Endoscopy. 2006;38:935–939. doi:10.1055/s-2006-944734.CrossRefPubMed

56.

Stevens T, Costanzo A, Lopez R, Kapural L, Parsi MA, Vargo JJ. Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2012;10:186.e1–191.e1. doi:10.1016/j.cgh.2011.09.006.CrossRef

57.

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;29:979–984. doi:10.1111/j.1365-2036.2009.03963.x.CrossRefPubMed

58.

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;44:127–134. doi:10.1097/MCG.0b013e3181bb854d.CrossRefPubMed

59.

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;54:2330–2337. doi:10.1007/s10620-008-0651-x.CrossRefPubMed

60.

Sey MS, 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–E59. doi:10.1055/s-0034-1377919.PubMed

61.

LeBlanc JK, DeWitt J, Johnson C, et al. A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain. Gastrointest Endosc. 2009;69:835–842. doi:10.1016/j.gie.2008.05.071.CrossRefPubMed

62.

Vijungco JD, Prinz RA. Management of biliary and duodenal complications of chronic pancreatitis. World J Surg. 2003;27:1258–1270. doi:10.1007/s00268-003-7246-7.CrossRefPubMed

63.

Sand JA, Nordback IH. Management of cholestasis in patients with chronic pancreatitis: Evaluation of a treatment protocol. Eur J Surg. 1995;161:587–592.PubMed

64.

Stahl TJ, Allen MO, Ansel HJ, Vennes JA. Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage. Ann Surg. 1988;207:26–32.CrossRefPubMedPubMedCentral

65.

Hammel P, Couvelard A, O’Toole D, et al. Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. N Engl J Med. 2001;344:418–423. doi:10.1056/NEJM200102083440604.CrossRefPubMed

66.

Frey CF, Suzuki M, Isaji S. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg. 1990;14:59–69.CrossRefPubMed

67.

Arslanlar S, Jain R. Benign biliary strictures related to chronic pancreatitis: Balloons, stents, or surgery. Curr Treat Options Gastroenterol. 2007;10:369–375.CrossRefPubMed

68.

van Boeckel PG, Vleggaar FP, Siersema PD. Plastic or metal stents for benign extrahepatic biliary strictures: A systematic review. BMC Gastroenterol. 2009;9:96. doi:10.1186/1471-230X-9-96.CrossRefPubMedPubMedCentral

69.

Catalano MF, Linder JD, George S, Alcocer E, Geenen JE. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: Comparison of single vs. multiple simultaneous stents. Gastrointest Endosc. 2004;60:945–952.CrossRefPubMed

70.

Pozsar J, Sahin P, Laszlo F, Forro G, Topa L. Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents. J Clin Gastroenterol. 2004;38:118–123.CrossRefPubMed

71.

Lawrence C, Romagnuolo J, Payne KM, Hawes RH, Cotton PB. Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: Comparing standard and prolonged stent change intervals. Gastrointest Endosc. 2010;72:558–563. doi:10.1016/j.gie.2010.05.029.CrossRefPubMed

Title: Endoscopic Therapies for Chronic Pancreatitis
Authors: Jeffrey M. Adler
Timothy B. Gardner
Publication date: 01-07-2017
Publisher: Springer US
Published in: Digestive Diseases and Sciences / Issue 7/2017
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-017-4502-5

Obesity Clinical Trial Summary

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.

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

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.

Watch now

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

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2017

Editors’ Introduction to the Chronic Pancreatitis and Pancreatic Cysts Special Issue

Imaging Pancreatic Cysts with CT and MRI

Surgical Approaches to Chronic Pancreatitis: Indications and Techniques

Novel and Experimental Therapies in Chronic Pancreatitis

Surgical Management of Pancreatic Cysts: A Shifting Paradigm Toward Selective Resection

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage