scholarly journals Motion – Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments Against the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 61-63 ◽  
Author(s):  
Darwin L Conwell
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Major Complication ◽  
Difficult Problem ◽  
Pancreatic Pseudocysts ◽  
Success Rates ◽  
Endoscopic Techniques ◽  
Large Numbers ◽  
Pancreatic Disorders

Endoscopic therapy can be used to dilate strictures in the pancreatic duct, remove stones and drain pseudocysts. In addition, it provides an alternative to surgery for the management of pain in patients with chronic pancreatitis. Pain is a difficult problem in these patients, especially if substance abuse is present, and its medical management is generally unsatisfactory. The concept that pancreatic pain is related to increased pressure in the main pancreatic duct is unproven, and is not supported by the results of surgical intervention. Although pancreatic stenting is often technically successful at achieving drainage of the pancreatic duct and relieving pain over the short term, pain usually recurs with time, complications are frequent, and repeated stent changes are usually necessary. Pancreatic pseudocysts can be drained endoscopically, using transpapillary, cystogastrostomy or cystoduodenostomy approaches, but success rates are less than 50% and bleeding is a major complication. Pseudocysts should not be drained unless they are symptomatic, causing complications or enlarging. There have been no published studies comparing endoscopic with surgical or radiological modalities. Endoscopic therapy of pancreatic disorders is a new and interesting technique, but initial promising results need to be confirmed in large, well-designed clinical trials. Such studies would need to enrol large numbers of patients, and involve measurement of technical success, pain severity and quality of life parameters. At present, endoscopic techniques must be considered experimental.

scholarly journals Motion - Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments for the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 57-59
Author(s):  
Stanley M Branch
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Clinical Problem ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Ducts ◽  
Success Rates ◽  
Long Term Follow Up

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

scholarly journals Benign Pancreatic Duct Strictures: Medical and Endoscopic Therapy

2000 ◽  
Vol 14 (2) ◽  
pp. 127-129
Author(s):  
JE Geenen
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Pancreatic Neoplasm ◽  
Pancreatic Disease ◽  
Therapy Options

Pancreatic duct strictures usually reflect underlying pancreatic disease and are likely caused by one or more of the following: acute or chronic pancreatitis, benign or malignant pancreatic neoplasm, pseudocyst and trauma. The characteristics of pancreatic strictures are identified, and medical and endoscopic therapy options are reviewed.

Indications for preoperative ERCP

Swiss Surgery ◽  
2000 ◽  
Vol 6 (5) ◽  
pp. 216-219 ◽  
Author(s):  
Seibold
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chronic Pancreatitis ◽  
Endoscopic Therapy ◽  
Pancreatic Head ◽  
Primary Diagnosis ◽  
Pancreatic Pseudocysts ◽  
Therapeutic Procedure ◽  
Cystic Neoplasms ◽  
Non Invasive ◽  
Refractory Pain

The indication for preoperative ERCP is about to be changed after the introduction of MRCP. There are however advantages of ERCP especially if the option of a therapeutic procedure, e.g., extraction of stones or placing of stents is considered. Besides ERCP prior laparoscopic cholecystectomy which is discussed elsewhere in this journal, indications for preoperative ERCP consist in patients after concussion trauma and hyperamylasemia as long as CT or MRI are not able to show pancreatic duct rupture. In this context the possibility of a stent placement is a major advantage of ERCP, since surgery may be avoided by this procedure. Preoperative ERCP may be performed in patients with chronic pancreatitis and refractory pain with the option of endoscopic therapy in cases with limited findings (less than 3 stones located in the pancreatic head). Furthermore, ERCP plays an important role in the preoperative differentiation between cystic neoplasms and pancreatic pseudocysts. Pseudocysts may be cured by endoscopical placement of transpapillary, transgastric or transduodenal stents. But so far no prospective studies have compared surgical with endoscopical drainage of pseudocysts. Finally, ERCP in the primary diagnosis of pancreatic carcinoma plays only a limited role and should be performed only if non-invasive methods are not able to clarify the situation.

scholarly journals Prospective observational study on pancreatic duct system diversity in different pancreatic diseases

2017 ◽  
Vol 4 (10) ◽  
pp. 3330
Author(s):  
Navjot Singh Brar ◽  
Rajbir Singh Bajwa
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Lemon Juice ◽  
Imaging Modalities ◽  
Cystic Neoplasm ◽  
Pancreatic Diseases ◽  
Ductal System ◽  
Pancreatic Disorders

Background: Pancreatology and pancreatic surgery was developed on the basis of increase in knowledge of anatomy and physiology of the pancreas in the beginning of the 20th century. Although our knowledge of pancreatic head anatomy has increased, anatomical data characterizing the pancreatic ductal system remain limited. Furthermore, the relation of pancreatic ductal system anomalies and different pancreatic disorders remain to be evaluated.Methods: The present study was conducted in Department of Paediatric, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar from August 2014 to November 2016. Total 50 subjects were included. Study was done with aim to study cases clinically and segregate cases with pancreatic disorder which need evaluation by special imaging modalities and surgical management, to compare the nature of information obtained from various modalities to study various corollaries of modern imaging study, to study whether the information from various imaging modalities are complimentary, competitive and to study pancreatic ductal structure in different pancreatic diseases.Results: In the present study, we have a total of 50 patients. Among them 25 (50%) suffer from chronic pancreatitis, 13 (26%) from acute pancreatitis, 6 (12%) from periampullary carcinoma, 3 (6%) from carcinoma head of the pancreas, 1 (2%) from pancreatic ascites following acute pancreatitis, 1 (2%) from annular pancreas and 1 (2%) from cystic neoplasm of pancreas. These patients were investigated by transabdominal USG, MDCT scan, ERCP and conventional and stimulated MRCP to study the pancreatic duct diversities in different pancreatic diseases and the advantage of lemon juice stimulated MRCP over conventional MRCP.Conclusions: Pancreatic disorders were most frequently seen in male patients. Age group between 31 to 50 years were mostly suffering from inflammatory disorders like acute and chronic pancreatitis. The frequency of malignant condition was increased after 50 years of age. Most common pancreatic disorder in our study was chronic pancreatitis. Trans-abdominal USG was found to be very useful initial investigation for the evaluation of pancreatic duct morphology. Best investigation for malignant pancreatic condition was MDCT following pancreatic protocol.

scholarly journals The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis

2020 ◽  
Vol 109 (1) ◽  
pp. 69-78 ◽  
Author(s):  
M. Udd ◽  
L. Kylänpää ◽  
A. Kokkola
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Hospital Admissions ◽  
Endoscopic Therapy ◽  
Treatment Options ◽  
Biliary Duct ◽  
Heavy Alcohol Consumption ◽  
Pancreatic Duct Stone

Chronic pancreatitis is a long-term illness leading to hospital admissions and readmission. This disease is often caused by heavy alcohol consumption and smoking. Patients with chronic pancreatitis suffer from acute or chronic pain episodes, recurrent pancreatitis, and complications, such as pseudocysts, biliary duct strictures, and pancreatic duct fistulas. Pancreatic duct strictures and stones may increase intraductal pressure and cause pain. Endoscopic therapy is aiming at decompressing the pressure and relieving the pain, most commonly with pancreatic duct stents and pancreatic duct stone retrieval. Early surgery is another option to treat the pain. In addition, endotherapy has been successful in treating complications related to chronic pancreatitis. The therapy should be individually chosen in a multidisciplinary meeting. Endoscopic therapy and surgery as treatment options for chronic pancreatitis are discussed in this review.

scholarly journals Lėtinio pankreatito ir kasos pseudocistų endoskopinio gydymo ankstyvieji rezultatai

2004 ◽  
Vol 2 (4) ◽  
pp. 0-0
Author(s):  
Gintautas Radžiūnas ◽  
Girstautė Dagytė ◽  
Narimantas Evaldas Samalavičius
Keyword(s):  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Endoscopic Treatment ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Procedures ◽  
Pancreatic Stones ◽  
Early Results ◽  
Pancreatic Duct Stenting

Gintautas Radžiūnas, Girstautė Dagytė, Narimantas Evaldas SamalavičiusVilniaus universiteto ligoninės"Santariškių klinikos" Centro filialas,Žygimantų g. 3, LT-01102 VilniusEl. paštas: [email protected] Tikslas Ankstyvųjų lėtinio pankreatito ir kasos pseudocistų endoskopinio gydymo rezultatų įvertinimas. Ligoniai ir metodai Retrospektyviai išanalizuoti 1992–2003 metais Vilniaus universitetinėje Centro ligoninėje endoskopiškai gydyti ligoniai, sirgę lėtiniu pankreatitu ar kasos pseudocista. Iš viso endoskopiškai gydyta 50 tokių ligonių, iš jų 39 vyrai ir 11 moterų. Ligonių amžius – 23–87 metai, vidutinis – 45,8 ± 1,7 metų. Rezultatai Visi ligoniai skundėsi skausmu, 20 – pykinimu, vėmimu, 11 ligonių karščiavo, 8-iems buvo gelta. ERCP atlikta 44 ligoniams, 6 ligoniams transmuralinis pseudocistos drenavimas atliktas be ERCP. ERCP ir cistogastrostomijos ar cistoduodenostomijos metu nustatyti tokie patologiniai pokyčiai: kasos pseudocistos – 35 ligoniams (17 ligonių (49%) pseudocista turėjo ryšį su kasos lataku), išsiplėtęs kasos latakas – 22 ligoniams, kasos latako stenozė – 11 ligonių, bendrojo tulžies latako išsiplėtimas – 11 ligonių, bendrojo tulžies latako stenozė – 8 ligoniams, kasos latako akmenligė – 5 ligoniams. Pseudocistos buvo 2–20 cm dydžio, vidutiniškai 6,9 ± 0,9 cm. Atliktos tokios endoskopinės procedūros: kasos latako sfinkterotomija – 25 ligoniams, papilosfinkterotomija – 18 ligonių, cistoduodenostomija – 13 ligonių, cistogastrostomija – 11 ligonių, kasos latakas stentuotas 5 ligoniams, bendrasis tulžies latakas – 5 ligoniams, kasos latako akmenys pašalinti 3 ligoniams. Komplikacijų buvo 8 ligoniams (16%), 4 ligoniams (8%) dėl komplikacijų reikėjo atlikti chirurginę operaciją. Dar 10 ligonių (20%) buvo operuoti, nes po atliktų endoskopinių procedūrų nusiskundimai nesumažėjo. Taigi vien endoskopiškai gydyti 36 iš 50 ligonių (72%) ir jų gydymo rezultatas vertintas kaip geras. Nė vienas ligonis po atliktų endoskopinių procedūrų ir po chirurginių operacijų nemirė. Išvados Endoskopinis lėtinio pankreatito ir kasos pseudocistų gydymas buvo veiksmingas 72% ligonių, komplikacijų buvo 16% ligonių. Endoskopinis lėtinio pankreatito ir kasos pseudocistų gydymas – tradicinių chirurginių operacijų alternatyva. Prasminiai žodžiai: ERCP, lėtinis pankreatitas, kasos pseudocistos, endoskopinis stentavimas, mechaninė gelta Early results of endoscopic treatment of chronic pancreatitis and pancreatic pseudocysts Gintautas Radžiūnas, Girstautė Dagytė, Narimantas Evaldas Samalavičius Objective Evaluation of early results of endoscopic treatment of chronic pancreatitis and pancreatic pseudocysts. Patients and methods A retrospective analysis of patients who had undergone endoscopic procedures because of chronic pancreatitis and pancreatic pseudocysts in 1992–2003 at the Vilnius University Center Hospital was carried out. Endoscopic treatment was undertaken for 50 patients (39 male and 11 female), age range 23–87 (45.8±1.7) years. Results Thirty-five patients had pseudocysts, 22 dilated pancreatic duct, 11 stenosis of the pancreatic duct, 11 dilated common bile duct, 8 common bile duct stenosis, and 5 had pancreatic stones. The following endoscopic procedures were carried out: pancreatic sphincterotomy in 25, biliary sphincterotomy 18, cystoduodenostomy 13, cystogastrostomy 11, pancreatic duct stenting 5, bile duct stenting 5, removal of pancreatic stones in 3 cases. Complications of endoscopic treatment developed in 16% of cases. A good result of endoscopic treatment was achieved in 36 out of 50 patients (72%). There was no lethality in this series. Conclusions Endoscopic treatment of chronic pancreatitis and pancreatic pseudocysts was effective in 72% of cases, complications developed in 16%. Endoscopic treatment of chronic pancreatitis and pancreatic pseudocysts is an alternative to traditional surgery. Keywords: ERCP, chronic pancreatitis, pancreatic pseudocyst, endoscopic stenting, obstructive jaundice

scholarly journals Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Endoscopy ◽  
2019 ◽  
Vol 51 (02) ◽  
pp. 179-193 ◽  
Author(s):  
Jean-Marc Dumonceau ◽  
Myriam Delhaye ◽  
Andrea Tringali ◽  
Marianna Arvanitakis ◽  
Andres Sanchez-Yague ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Plastic Stents ◽  
Spontaneous Clearance ◽  
Pancreatic Stones ◽  
Moderate Quality ◽  
Short Disease Duration ◽  
Quality Evidence

Main RecommendationsESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

scholarly journals Risk Factors for Migration, Fracture, and Dislocation of Pancreatic Stents

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yoshiaki Kawaguchi ◽  
Jung-Chun Lin ◽  
Yohei Kawashima ◽  
Atsuko Maruno ◽  
Hiroyuki Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Stent Migration ◽  
Success Rates ◽  
Patient Factors ◽  
Minor Papilla ◽  
Stent Retrieval ◽  
Duct Stenosis ◽  
Pancreatic Sphincterotomy

Aim. To analyze the risk factors for pancreatic stent migration, dislocation, and fracture in chronic pancreatitis patients with pancreatic strictures.Materials and Methods. Endoscopic stent placements (total 386 times) were performed in 99 chronic pancreatitis patients with pancreatic duct stenosis at our institution between April 2006 and June 2014. We retrospectively examined the frequency of stent migration, dislocation, and fracture and analyzed the patient factors and stent factors. We also investigated the retrieval methods for migrated and fractured stents and their success rates.Results. The frequencies of stent migration, dislocation, and fracture were 1.5% (5/396), 0.8% (3/396), and 1.2% (4/396), respectively. No significant differences in the rates of migration, dislocation, or fracture were noted on the patient factors (etiology, cases undergoing endoscopic pancreatic sphincterotomy, location of pancreatic duct stenosis, existence of pancreatic stone, and approach from the main or minor papilla) and stent factors (duration of stent placement, numbers of stent placements, stent shape, diameter, and length). Stent retrieval was successful in all cases of migration. In cases of fractured stents, retrieval was successful in 2 of 4 cases.Conclusion. Stent migration, fracture, and dislocation are relatively rare, but possible complications. A good understanding of retrieval techniques is necessary.

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