Therapeutic pancreatic endoscopy.

Abstract

Pharmacological treatment and/or temporary pancreatic stenting can reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography. Potential candidates are patients who are at high risk for this complication. Extensive diagnostic work-up is needed for patients with acute recurrent pancreatitis before treatment can be planned. Endoscopic pancreatic sphincterotomy or temporary stenting, or both, appear to be beneficial in idiopathic recurrent pancreatitis. Short-term stent placement in the dorsal duct, with or without papillotomy of the minor papilla, is a promising approach in patients with symptomatic pancreas divisum, particularly if it is associated with acute recurrent pancreatitis. Endoscopic treatment of chronic obstructive pancreatitis is technically effective and safe, but the indication remains controversial, mainly due to a lack of controlled trials. Endoscopic transmural drainage of pancreatic pseudocysts or abscesses is very effective, and should be considered as a primary approach in symptomatic patients. The endoscopic ultrasonography-guided technique extends the options for obtaining access to fluid collections in difficult locations, and may further increase the safety of the procedure. Many of these procedures are technically demanding, and should be restricted to high-volume centers; there is a continuing need for further evaluation and comparison with alternative strategies.