Endotherapy for Pain in Chronic Pancreatitis

Sudeep Khanna; Rakesh K. Tandon

Disclosures

J Gastroenterol Hepatol. 2008;23(11):1649-1656. 

In This Article

Conclusions

Although the methodology of studies used to generate available data on endotherapy for pain in CP is imperfect, for the reasons cited earlier, the cumulative weight of data are sufficient for various Endoscopy Societies to endorse the use of endotherapy for treatment of persistent or relapsing pain in CP. Endotherapy is less invasive than surgery, gives similar results, and keeps open the option for a surgical intervention in future. A scheduled stent exchange may not be required. Stent may be replaced if there is recurrence of pain during the first year post stenting and then removed after one year of stent in situ. Pancreatic stent placement is not associated with significant long-term side-effects. However, further studies of the role of endotherapy for maintaining or improving exocrine and endocrine pancreatic functions are required. A tentative conclusion is that improvement or continuing deterioration may depend on the etiology of pancreatitis, particularly alcohol versus tropical calcific pancreatitis. Further, prospective, preferably randomized, controlled trials applying strict selection criteria based on etiology, site of dominant stricture, presence or absence of stones, and similar instruments (such as for pain assessment) to measure end-points will help remove doubts about the role of endotherapy for relieving pain in CP. Surgery still plays a major role if endotherapy fails and remains an option as first line therapy in patients with CP and multiple large pancreatic duct stones. Lithotripsy is also of interest in the latter group, and further comparative trials are awaited with interest.


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