10Endoscopic technique for the management of pancreatitis and its complications
Section snippets
Gallstone-associated acute pancreatitis
In Western countries, gallstones account for about half the cases of AP. They often occur during middle age or later, and are more common in women.6
The pathogenesis of AP is due to the transient obstruction of the main pancreatic duct (MPD) and/or possible biliary reflux in the MPD.7., 8. There is experimental evidence that the severity of AP is proportional to the duration of pancreatic duct obstruction.8 This justifies the attempts to remove stones early in human gallstone pancreatitis.
The
Chronic pancreatitis
Chronic pancreatitis (CP) is a progressive disease for which there is no curative treatment. Therapeutic efforts have therefore concentrated on alleviating the severe pain associated with this condition.
Interventional endoscopy has been increasingly used to treat CP over the last 20 years, with clinical results comparable to those of conventional surgery.70., 71. However, unlike surgery, endoscopic therapy can be repeated in response to the recurrence of pain, and has a high clinical success
Summary
Thanks to the low invasiveness and safety of endoscopic therapy, it is now widely used as a first-line treatment for patients with acute or chronic pancreatitis.
In gallstone pancreatitis, the results of four randomized controlled studies in which endoscopic treatment was compared to conservative management indicate that the use of ERCP/ES should depend on the predicted severity of the disease and on its biliary symptoms.
In recurrent acute idiopathic pancreatitis, whether or not it is associated
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Cited by (53)
Pancreatic Interventions in Acute Pancreatitis: Ascites, Fistulae, Leaks, and Other Disruptions
2018, ERCP, Third EditionGallstone Pancreatitis. A Review
2014, Surgical Clinics of North AmericaCitation Excerpt :The goal of cholecystectomy is to prevent recurrence of GSP by removing the source of secondary gallstones. Although 1% to 2% of patients may recur even after cholecystectomy, the rate of recurrence in untreated patients with GSP is up to two-thirds of patients within 3 months of index presentation.72–75 Recurrent GSP may be graver than the initial presentation, as between 4% and 50% of cases are reported as severe, and mortality and morbidity is reported in up to 10% and 40%, respectively.13,76,77
Key Points
2013, ERCP: Second EditionEndoscopic biliopancreatic investigations and therapy
2008, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :In cases of mild ABP, the indications for ERCP with sphincterotomy are basically the following: presence of gallstones plus high operative risk, absence of gallstones or prior cholecystectomy, and pregnancy. ERCP is indicated for the evaluation and treatment of benign biliary strictures, especially postoperative biliary strictures,26,27 main duct strictures in primary sclerosing cholangitis,27,28 and – in selected cases – CBD strictures due to chronic pancreatitis.27,29–31 The endoscopic treatment of benign strictures includes mechanical or pneumatic dilations and the placement of plastic stents.