Abstract
The principle of endotherapy in chronic pancreatitis is based on the premise that obstruction to the flow of pancreatic juice causes pancreatic-duct hypertension and increased pancreatic parenchymal pressures, which, in turn, induces pain. Strictures, stones, and a disrupted duct are the 3 main causes of obstruction in chronic pancreatitis. Apart from chronic pancreatitis, anastomotic stricture after a Whipple procedure can cause pancreatic-duct obstruction and lead to pain. Decompression of the obstructive pancreatic duct at ERCP leads to complete or partial relief of symptoms in 60% to 80% of patients. Patients who fail treatment by ERCP and those in whom ERCP is technically unsuccessful undergo surgery or are conservatively managed. Recently, EUS has been advocated as a rescue technique for management of patients in whom ERCP is technically unsuccessful. This section of the EUS 2008 Working Group Proceedings evaluates the current evidence and potential role of EUS in the management of symptomatic patients with obstructive pancreatic duct from benign causes in whom ERCP is technically unsuccessful.
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