Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

Abstract

Chronic pancreatitis is a progressive inflammatory disease of the pancreas potentially giving rise to several complications. For this reason, patients need long-term care and treatment by medical, interventional, and sometimes surgical measures. This article reviews current state-of-the-art strategies and guidelines for treating chronic pancreatitis with conventional and endoscopic measures.

Conservative Treatment of Chronic Pancreatitis: A Practical Approach

“…Patients should be screened for the presence of possible occult systemic complications such as osteoporosis, malnutrition, liposoluble vitamin deficiency, small bacterial intestinal overgrowth (SIBO), as well as locoregional ones, such as biliary or gastric outlet obstruction, vein thrombosis, pseudocyst and main pancreatic duct (MPD) strictures or stones (Fig. 1) (27–29). Cancer should be excluded at diagnosis and acknowledged among the endpoints of medical follow-up, especially in cases harboring a genetic background (PRSS1) or with long-standing risk factors (smoking, alcohol, diabetes, family history for cancer) (30).…”

“…PERT is a porcine derivate and does not interfere with human fecal elastase that is used to test exocrine function. All patients, including the ones with Islamic and Jewish faith, can be under PERT treatment (28). PERT usually works, is well tolerated without side effects, and can be administered in all patients.…”

“…PERT usually works, is well tolerated without side effects, and can be administered in all patients. The only known possible side effect is fibrosing disease of the colon which has been rarely described in patients affected by cystic fibrosis (28, 32).…”

“…Endoscopic therapy in chronic pancreatitis has main aim to improve pain and to manage chronic pancreatitis local complications. The main locoregional complications of chronic pancreatitis, often also involved in the genesis of pancreatic pain, are MPD stones or strictures, the biliary strictures, and the development of pseudocysts (28, 49). MPD stones might be multiple or solitary and affect up to 62% of patients.…”

“…Regarding the caliber of stents, it has been shown that “the bigger the better” with 10-Fr stents harboring 3-fold less hospitalization and pain compared with 8.5 Fr (49). If the MPD stricture do not respond to the dilative treatment with a single stent, a multiple plastic stents strategy can also be tried (28). Costamagna et al reported in a prospective study on 19 patients that the insertion of multiple pancreatic stents could achieve therapeutic success after the failure of single plastic stent strategy.…”