Italian consensus guidelines for chronic pancreatitis

Abstract

This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: A Dutch national survey

“…In the recently published South African guidelines, transabdominal US is considered to carry limited value because of lack of sensitivity and specificity [12]. The Italian guidelines promote transabdominal US in confirming the diagnosis of advanced chronic pancreatitis, since it identifies gross abnormalities of the pancreas, e.g., dilatation of the pancreatic duct [11]. However, the main value of transabdominal US is the ability to differentiate chronic pancreatitis from other causes of abdominal pain.…”

“…Nevertheless, several recommendations on therapy in chronic pancreatitis have been published [6,7,8,9,10]. In addition two recent guidelines have been published [11,12]. In 2010 the Italian Association for the Study of the Pancreas published an Italian consensus regarding diagnosis and treatment in chronic pancreatitis.…”

“…In 2010 the Italian Association for the Study of the Pancreas published an Italian consensus regarding diagnosis and treatment in chronic pancreatitis. This consensus appraised the best available evidence combined with input from experts [11]. After a consensus meeting several statements on the diagnosis and treatment on chronic pancreatitis were made.…”

The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma

“…Despite these advances, differential diagnosis between mass-forming chronic pancreatitis, ductal adenocarcinoma, and autoimmune pancreatitis based on only CT image can be challenging (2,3). The vast majority of solid malignancies of the pancreas are hypovascularized and will therefore present low attenuation on contrast enhanced CT.…”

Diagnosis of pancreatic exocrine insufficiency in chronic pancreatitis

“…Most experts agree that diagnosis of CP depends on a combination of clinical, histological, imaging and functional criteria (5,14,16,32). Proof of impaired exocrine function by function testing is particularly important for diagnosis of CP in patients with inconclusive morphological findings.…”