Via practica 10/2006

ENDOSCOPIC TREATMENT OF CHRONIC PANCREATITIS

Chronic pancreatitis is a progressive inflammatory disease of pancreas. The clinical manifestation usually includes pain, atacks of acute pancreatitis, malabsorption and hyperglycemia/diabetes. Therapy is symptomatic and involves mainly pain management. If medical treatment is unsuccessful, in some cases endoscopic or surgical therapy need to be used. The morbidity and mortality of endoscopic therapy is lower than that of surgical treatment, however it has worse long term outcomes in regards to its effectiveness compared to surgical treatment. The endoscopic therapy involves pancreatic/possibly also choledochal/papilosphincterotomy. This procedure helps to gain sufficient access to pancreatic duct and enables other treatments: dilatation of stenoses, stent implantation into choledochal and pancreatic ducts, extraction of concrements, pseudocyst drainage, neurolysis of celiac ganglion etc. The short term success rate is high. The complications are infrequent if performed by experienced endoscopist. Endoscopic therapy of chronic pancreatitis brings many exciting possibilities at present. Careful selection of patients is necessary in order to get optimal results of this treatment. Unfortunately, definite guidelines for application of endoscopic therapy in chronic pancreatitis are still missing secondary to the lack of clinical trials comparing surgical and endoscopic treatment.

Keywords: chronic pancreatitis, papilosphincterotomy, stent implantation, concrement extraction.