title: New developments in endoscopic treatment of chronic pancreatitis.
abstract: The aim of endoscopic therapy of chronic pancreatitis (CP) is to treat pain by draining the pancreatic duct or managing loco-regional complications. Recent decennia were characterized by continuous improvement of endoscopic techniques and devices, resulting in a better clinical outcome. Novel developments now also provide the opportunity to endoscopically treat refractory CP-related complications. Especially suboptimal surgical candidates could potentially benefit from these new developments, consequently avoiding invasive surgery. The use of fully covered self-expandable metal stents (SEMS) has been explored in pancreatic and CP-related biliary duct strictures, resistant to conventional treatment with plastic endoprotheses. Furthermore, endosonography-guided transmural drainage of the main pancreatic duct via duct-gastrostomy is an alternative treatment option in selected cases. Pancreatic pseudocysts represent an excellent indication for endoscopic therapy with some recent case series demonstrating effective drainage with the use of a fully covered SEMS. Although results of these new endoscopic developments are promising, high quality randomized trials are required to determine their definite role in the management of chronic pancreatitis.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Rotterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Didden
authors.forename: M
authors.initials: M
authors.lastname: Bruno
authors.forename: J W
authors.initials: JW
authors.lastname: Poley
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D003251:Constriction, Pathologic; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods