Endoscopic Treatment of Patients with Chronic Pancreatitis

Relapsing chronic pancreatitis is often caused by elevated pressure within the pancreatic duct due to impaired pancreatic juice outflow in the presence of pancreatic duct stricture or stones formed by chronic pancreatic inflammation. Most of this condition is alcoholic, and patients should stop drinking as a treatment. Alleviating the impaired pancreatic juice outflow and decompressing the pancreatic duct constitute a reasonable treatment approach for relapsing pancreatitis. Methods available for pancreatic duct decompression include surgical procedure such as pancreatectomy or pancreaticojejunostomy, extracorporeal shock wave lithotripsy and endoscopic treatment (e.g., endoscopic pancreatic duct stenting). Endoscopic stenting has been increasingly used as a minimally invasive method of treating pancreatic duct stricture, but it involves several problems. If the pancreatic stones are large, a combination of this procedure and extracorporeal shock wave lithotripsy will allow easier stone removal and stenting. Differentiating the benign from malignant nature of the pancreatic duct stricture is important. Sufficient understanding of the accidental symptoms that accompany stent insertion is also necessary. In patients with intense pancreatic duct stricture, which makes stenting difficult; patients in which the stricture fails to alleviate even after successful stenting and thus requires stent replacement; and patients with large pancreatic stones that are difficult to eliminate by using extracorporeal shock wave lithotripsy, surgery is an essential treatment option that should be performed without delay. Pancreatic duct stenting is greatly useful in controlling and preventing symptoms of relapsing obstructive chronic pancreatitis, although it involves many issues related to indications, insertion period, form and diameter of the stent to be inserted, and medico-economic aspects.