Endotherapy For Chronic Pancreatitis Research Articles

Endoscopic treatment of pain in chronic pancreatitis

Pain is the most common symptom of chronic pancreatitis, having a profound effect on patients and a broad socioeconomic impact. Endoscopy is guideline recommended as first-line management for chronic pancreatitis pain in certain clinical scenarios. Herein, we provide an evidence-based review of the endoscopic treatment of pain due to chronic pancreatitis while highlighting some important confounders in the measurement of this outcome in clinical practice and research. Multiple recent studies have reported on the efficacy of current endoscopic therapies for chronic pancreatitis pain. Despite the high technical success rates of these procedures, pain outcomes remain disappointing. Complex mechanisms beyond ductal hypertension, such as central sensitization, visceral hypersensitivity and inflammatory neuritis account for some of the discordance observed between the rates of technical and clinical success. In addition, the sham effect is increasingly recognized as a confounder when interpreting the procedural benefit. Nevertheless, there are multiple promising innovations in the field of pancreatic endoscopy that are aimed to improve technical and clinical outcomes, but rigorous investigation is necessary to establish their role in clinical practice. Endoscopic therapy for chronic pancreatitis pain appears to be safe and effective in certain contexts and recent innovations in the field will hopefully further improve outcomes. In addition to evaluating the technical success of endotherapy in chronic pancreatitis, methodologically rigorous research focusing on patient-centered outcomes and accounting for the sham effect is necessary to advance this field.

Endoscopic treatment of intraductal pancreatic stent fragmentation.

Complications of endoscopic treatment are reported more and more often as a result of popularization of pancreatic endotherapy. Our study presents the results of treatment in patients with intraductal pancreatic stent fragmentation diagnosed during endotherapy of chronic pancreatitis. Retrospective analysis of 2496 endoscopic retrograde cholangiopancreatography procedures which were carried out in 607 patients at the Gastrointestinal Endoscopy Unit of the University Clinical Center in Gdansk. In the course of pancreatic endotherapy, intraductal pancreatic stent fragmentation was stated during 33 of 2496 (0.013%) procedures in 33 of 607 (5.44%) patients with chronic pancreatitis. In 33 patients, there were 46 intraductal fragments of broken stents. Most patients were asymptomatic. In 31/33 patients, fragments of broken stents were removed from the pancreatic duct endoscopically. In the case of two patients, endoscopic management was ineffective and they were treated surgically. Altogether, 44/46 stent fragments were removed endoscopically. Most fragments of pancreatic stents were removed during the first endoscopic procedure. One fragment of a broken stent was retrieved with polypectomy snare and four with Dormia basket. The remaining fragments of broken pancreatic stents were removed with rat-tooth forceps. Intraductal fragmentation of pancreatic stent is a rare complication of pancreatic endotherapy and it often has an asymptomatic course. Most fragments of broken pancreatic stents can be removed endoscopically from the pancreatic duct with an acceptable complication rate.

Su1277 - Endoscopic Ultrasound as a Predictor and Guide to Successful Endotherapy in Chronic Pancreatitis

Su1277 - Endoscopic Ultrasound as a Predictor and Guide to Successful Endotherapy in Chronic Pancreatitis

Advances in endotherapy in chronic pancreatitis

Advances in endotherapy in chronic pancreatitis

Endoscopic ultrasound as a predictor and guide to successful endotherapy in chronic pancreatitis

Background:Pancreatic calculi are sequelae of chronic pancreatitis (CP) and may obstruct pancreatic ducts leading to pain. Indications for endotherapy include nonimpacted <5 mm stones in the head of pancreas with the absence of downstream strictures. The assessment before endotherapy is done by magnetic resonance cholangiopancreatography/computed tomography.Objectives:To assess the modality of endoscopic ultrasound (EUS) as a roadmap before endoscopic retrograde cholangiopancreatography (ERCP) in patients planned for endotherapy in CP.Methods:The data of 412 patients with CP were retrospectively analyzed. A total of 143 were associated with stones in the head/papillary region of pancreas. Of these, around 75 were excluded and remaining 68 were evaluated by EUS using a linear/radial echoendoscope before ERCP.Results:Of 68 cases, 48 were associated with hard stones with acoustic shadowing while twenty were associated with soft stones without acoustic shadowing. In twenty soft stones cases, ERCP was successful in 18 patients. In 48 patients with hard stones, there was failure of endotherapy in forty patients which required extracorporeal shock wave lithotripsy/surgery. The presence of large, hard, immobile stones was negative predictors of successful endotherapy. Small, ampullary/papillary stones were positive predictors.Conclusions:EUS can influence therapeutic decisions before endotherapy and can prevent unsuccessful attempts improving overall success/prognosis. EUS has an additional advantage of making a diagnosis of ampullary/papillary stones and biliary obstruction which can be treated endoscopically. It can guide whether endotherapy needs to be performed through major or minor papilla. EUS by diagnosing pancreatic tumor/strictures missed on other imaging modalities allows early surgical reference and hence improves long-term prognosis.

Endoscopic ultrasound as a predictor and guide to successful endotherapy in chronic pancreatitis

Background and Objectives:Pancreatic calculi (PCs) are sequelae of chronic pancreatitis (CP) and may obstruct and produce ductal hypertension leading to pain, the cardinal feature of CP. Indications for endotherapy include stones <5 mm size, stones in the head of pancreas which are not impacted and absence of downstream strictures. The assessment before the procedure is done by magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT). However, problems are encountered during endoscopic retrograde cholangiopancreatography (ERCP) clearance which are not anticipated despite MRCP/CT. The problems are possible impacted stones, hard stones, indeterminate stricture, and change of finding during ERCP. Hence, controversy exists. Endoscopic ultrasound (EUS) can help by providing concordance or discordance with MRCP images and may help in further clarification. The aim of this study is to evaluate the role, feasibility, and management changes of EUS before ERCP in patients planned for endotherapy in CP. Another objective was to evaluate whether EUS features of pancreatic duct (PD) stones can serve as a predictor of successful removal during ERCP.Methods:The data of 412 patients during the study period (2009–2016) with CP were retrospectively analyzed. A total of 143 were associated with stones in head/papillary region of pancreas. Out of these, 75 were excluded and remaining 68 were evaluated by EUS using a linear/radial echoendoscope before ERCP.Results:Out of 68 cases, 48 were associated with hard stones with acoustic shadowing while 20 were associated with soft stones without acoustic shadowing. In 20 soft stones cases, ERCP was successful in 18 patients. In 48 with hard stones, there was failure of endotherapy in 40 which required extracorporeal shock wave lithotripsy (ESWL)/surgery. The presence of large (≥5mm), hard, immobile stones were negative predictors of successful endotherapy. Small, ampullary/papillary stones were positive predictors.Conclusion:The present study suggests that EUS can differentiate “soft PD stones” (without an acoustic shadow) from “hard PD stones”(with acoustic shadow). “Hard PD stones” are better managed by ESWL. An EUS can influence important therapeutic decisions before endotherapy and can prevent unsuccessful attempts at ERCP and thus improve overall success/prognosis. An EUS has an additional advantage of making a diagnosis of ampullary/papillary stones and biliary obstruction which can be treated endoscopically. It can guide whether endotherapy needs to be performed through major or minor papilla. EUS by diagnosing pancreatic tumor/strictures missed on other imaging modalities allows early surgical reference and hence improves long term prognosis.

Endotherapy for chronic pancreatitis: advantages and limitations

Chronic pancreatitis (CP) is pathologically characterized by fibrosis of pancreatic parenchyma.Treatment of CP is to alleviate pain and preserve pancreatic endo-/exo-crine function.Endotherapy,as a micro-invasive method,has been testified to be efficient and safe for pancreatic duct stones and stenosis,pancreatic pseudocyst and common bile duct stenosis secondary to CP.It has partially replaced the role of surgery in CP therapy.Whether endoscopic or surgical treatment has its limitations,CP treatment needs medicine,surgery,endoscopy,anesthesia,nutrition and other disciplines together to develop the best solution to improve the quality of life. Key words: Chronic pancreatitis; Endotherapy

Endotherapy in chronic pancreatitis

Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. Pancreatic ductal strictures are managed by single large bore stents. Multiple stents are placed for refractory strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.

What is the role of endotherapy in chronic pancreatitis?

Chronic pancreatitis (CP) can have debilitating clinical course due to chronic abdominal pain, malnutrition and related complications. Medical, endoscopic and surgical treatment of CP should aim at control of symptoms, prevention of progression of the disease and correction of complications. Endoscopic management plays a specific role in carefully selected patients as primary interventional therapy when medical measures fail or in high-risk surgical candidates. Endotherapy for CP is utilized also as a bridge to surgery or to assess potential response to pancreatic surgery. In this review we address the role of endotherapy for the relief of obstruction of the pancreatic duct (PD) and bile duct, closure of PD leaks and drainage of pseudocysts in the setting of CP. In addition, endotherapy for relief of pancreatic pain by endoscopic ultrasound-guided celiac plexus block for CP is discussed.

EUS 2008 Working Group document: evaluation of EUS-guided pancreatic-duct drainage (with video)

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.

Endotherapy for chronic pancreatitis with intracanalar stones

Endotherapy for pancreatic stone is an emerging specialty. The judicious application of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) in selected groups of patients has increased the success rates of endotherapy, with excellent long-term results. In this review the authors share their vast experience of treating patients with pancreatic stones. The article will focus on the basic principles of pancreatic endotherapy, the instrumentation required, details of the ESWL technique and its applications, as well as the limitations, success rate, and complications of endotherapy in selected patients.

Benign Pancreatic Duct (PD) Strictures in the Setting of Pancreas Divisum: Efficacy of Endotherapy

The evolution of therapeutic ERCP has allowed a wide range of treatment options for both biliary & pancreatic disorders with high rate of success at long-term F/U. Pancreatic endotherapy for benign pancreatic disease has gained wide-spread acceptance. Paramount in this setting is treatment of pts presenting with symptomatic chronic pancreatitis (CP), including drainage of pseudocysts, removal of PD stones, & dilation/stenting of PD strictures. This type of endotherapy is further challenging in the setting of Pancreas Divisum. Aim: To determine the success & type of endotherapy necessary in pts with CP with PD strictures in the setting of Pancreas Divisum. Methods: Over a 10-yr period, 47 pts (29 M, 18 W) with CP and dominant strictures in the setting of Pancreas Divisum were identified using a computer assisted retrieval system. These pts underwent endoscopic endotherapy including sphincterotomy (ES) (when applicable), dilation, stone extraction, & stenting (single vs serial). Pt presentation included: chronic pain (n = 36), acute pancreatitis (n = 8), wt loss (n = 6), abnormal imaging (n = 18), & diarrhea (n = 10). During that same interval, 268 pts presented with CP with PD stricture in the setting of dominant ventral duct. Pt presentation included: chronic pain (n = 210), acute pancreatitis (n = 35), wt loss (n = 61), abnormal imaging (n = 95), & diarrhea (n = 38). Results: In the Pancreas Divisum group, pts underwent a mean of 3.4 ERCPs (range 1-8), 11/47 (23%) had co-existing PD stone(s). Forty percent (19/47) pts had duct dilation (≥5 mm). Endoscopic ES was necessary in 22/47 pts (47%). Successful outcome (stone extraction, resolution of stricture and symptoms) was seen in 30/47 pts (64%). In the non Pancreas Divisum group, pts underwent a mean of 4.1 ERCP's (range 1-12). 55/268 (21%) had co-existing PD stone(s). 112/268 (42%) pts had duct dilation (≥5 mm). ES was necessary in 161/268 (68%). Successful outcome was seen in 156/268 (58%). Conclusion: Successful endotherapy in CP with associated dominant PD stricture occurs in the setting of Pancreas Divisum equal to those with dominant ventral pancreatic ducts. Symptom resolution is expected in 2/3 of pts following intense Rx. The co-existence of PD stones along with dominant PD stricture does not seem to prohibit response to therapy.

Therapeutic pancreatic endoscopy.

In view of increasingly accurate noninvasive diagnostic imaging modalities for pancreatic diseases, endoscopic retrograde cholangiopancreatography (ERCP) should be mainly restricted to therapeutic indications. Acute pancreatitis is still the most common complication of ERCP. Prevention measures should focus in particular on well-defined risk groups. Temporary pancreatic duct drainage, preferably using small-diameter endoprostheses, can reduce the incidence of post-ERCP pancreatitis in at-risk individuals. By contrast, pharmacological prevention does not appear to be effective. ERCP in conjunction with sphincter of Oddi manometry frequently reveals the diagnosis of undetermined causes of acute recurrent pancreatitis. Endoscopic sphincterotomy (EST) is the treatment of choice in patients with sphincter of Oddi dysfunction or papillary stenosis. For these indications, dual pancreaticobiliary sphincterotomy promises a lower early morbidity and a better long-term outcome than biliary EST alone. In patients with pancreatic divisum, the cannulation rate of the dorsal duct can be improved by methylene blue staining and/or stimulation of the pancreatic secretion. Papillotomy of the minor papilla with short-term stenting appears to be an effective and safe approach for associated acute recurrent pancreatitis. Large-scale trials indicate that the majority of symptomatic patients with chronic pancreatitis can be well managed in the long term by endoscopic interventions. There is still a lack of prospective randomized controlled trials on endotherapy for chronic pancreatitis; however, they are also lacking for the surgical approach. Endoscopic and/or endosonographically guided drainage has become the treatment of choice for the majority of symptomatic pancreatic pseudocysts. Transmural debridement of pancreatic abscesses and infected necroses is still investigational, but appears to offer a minimally invasive alternative to surgery in selected cases. Pancreatic endotherapy is technically demanding and potentially hazardous; these interventions should be restricted to high-volume centers with options for an interdisciplinary team approach. Methods that have not yet been established should be evaluated in carefully designed prospective trials.

Endotherapy of chronic pancreatitis (CP) in children and young adults

Endotherapy of chronic pancreatitis (CP) in children and young adults

Endoscopic therapy of chronic pancreatitis

Chronic pancreatitis is an inflammatory process characterized by destruction of pancreatic parenchyma and ductal structures with formation of fibrosis. Pain is the predominant symptom of chronic pancreatitis and its origin appears to be multifactorial. 1 Steer ML Waxman I Freedman S. Chronic pancreatitis. N Engl J Med. 1995; 332: 1482-1490 Crossref PubMed Scopus (585) Google Scholar , 2 Widdison AL Alvarez C Karanjia ND Reber HA. Experimental evidence of beneficial effects of ductal decompression in chronic pancreatitis. Endoscopy. 1991; 23: 151-154 Crossref PubMed Scopus (51) Google Scholar , 3 Karanjia ND Reber HA. The cause and management of the pain of chronic pancreatitis. Gastrointest Clin N Amer. 1990; 19: 895-904 PubMed Google Scholar , 4 Lo SK Lewis MPN Reber PU Patel A Sherman S Ashley SW Reber HA. In-vivo endoscopic trans-sphincteric measurement of pancreatic blood flow (PBF) in humans. Gastrointest Endosc. 1996; 43: 409A Abstract Full Text PDF Scopus (3) Google Scholar The multiplicity of causes of pain helps explain the mixed results achieved by current methods of therapy. Most therapeutic efforts in the treatment of chronic pancreatitis are directed toward control of symptoms. Medical therapies (dietary alterations, analgesics, nerve blocks, oral enzyme supplements, octreotide) are variably effective in relieving pain, 1 Steer ML Waxman I Freedman S. Chronic pancreatitis. N Engl J Med. 1995; 332: 1482-1490 Crossref PubMed Scopus (585) Google Scholar leaving surgical therapy as the main therapeutic option for patients who fail to improve with medical management. Early postoperative pain relief is seen in 80-90% of patients; however, pain recurs in 20-50% during long-term follow-up. 5 Bradley EL. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg. 1987; 153: 207-213 Abstract Full Text PDF PubMed Scopus (197) Google Scholar , 6 Malfertheiner P Buchler M. Indications for endoscopic or surgical therapy in chronic pancreatitis. Endoscopy. 1991; 23: 185-190 Crossref PubMed Scopus (26) Google Scholar Surgical drainage procedures are associated with a morbidity rate of 20-40% and an average mortality rate of 4%. 3 Karanjia ND Reber HA. The cause and management of the pain of chronic pancreatitis. Gastrointest Clin N Amer. 1990; 19: 895-904 PubMed Google Scholar While endoscopic therapy has revolutionized the approach to a variety of biliary tract disorders, it is only recently that the indications for therapeutic endoscopy have been expanded to include disorders of the pancreas. 7 Bedford RA Howerton DH Geenen JE. The current role of ERCP in the treatment of benign pancreatic disease. Endoscopy. 1994; 26: 113-119 Crossref PubMed Scopus (20) Google Scholar , 8 Kozarek RA Traverso LW. Endotherapy of chronic pancreatitis. Int J Pancreatol. 1996; 19: 93-102 PubMed Google Scholar , 9 Kaikaus RM Geenen JE. Current role of ERCP in the management of benign pancreatic disease. Endoscopy. 1996; 28: 131-137 Crossref Scopus (9) Google Scholar , 10 Sherman S Lehman GA. Endoscopic therapy of pancreatic disease. The Gastroenterologist. 1997; 5: 262-277 PubMed Google Scholar , 11 Kozarek RA Chronic pancreatitis in 1994: Is there a role for endoscopic treatment?. Endoscopy. 1994; 26: 625-628 Crossref PubMed Scopus (18) Google Scholar Although the endoscopic approach has not been compared directly to surgery, endoscopic drainage is appealing in that it may offer an alternative to surgical drainage procedures with generally less morbidity and mortality. Furthermore, endoscopic procedures do not preclude subsequent surgery, if necessary. Moreover, the outcome from reducing the intraductal pressure by endoscopic methods may be a predictor for the success of surgical drainage. 12 Huibregtse K Smits ME. Endoscopic management of diseases of the pancreas. Am J Gastroenterol. 1994; 89: S66-S77 PubMed Google Scholar

3712 ENDOTHERAPY FOR CHRONIC PANCREATITIS IN CHILDHOOD.

Background. Chronic pancreatitis (CP) may be responsible for pain and vomiting in children. Endotherapy (ET) including ESWL of severe CP with ductal obstruction has shown to be effective and safe in adults. Few data are available for children. Aim. To review immediate and medium-term results of ET for severe CP in children. Patients and Method. 18 children who underwent therapeutic ERCP for symptomatic CP (Jan 91 - Apr 99) were divided in 2 groups according to their age: children (C) (n=8, males n=2, hereditary/idiopathic 4/4, mean age at onset of disease 3.1y, range 1.5- 5.7y, mean age at ET 5y, range 2.4-6.7y) and teenagers (T) (n=10, males n=6, hereditary/idiopathic 0/10, mean age at onset of disease 10y, range 6- 13, mean age at ET 12y, range 9-14). All patients were European, except 2 teenagers from India. ERCP was always performed under general anesthesia in the supine position. The following Olympus duodenoscopes were used: PJF 7.5 (<3y), JF100 (3-4y), and TJF100-140 (>4y). ERCP findings: normal bile ducts 18/18; dilated MPD 18/18, calcified calculi 5/18, MPD stricture 9/18, dominant dorsal duct 4/18. Results were considered: a) “excellent” when no further pain occurred, b) “good” when pain decreased in frequency and intensity but ET was repeated for relapsing symptoms, c) “fair” when immediate results were good but the patient eventually underwent further surgery. Results. The following procedures were performed in the two groups (C-T), respectively: biliary sphincterotomy 8/8-9/10, pancreatic sphincterotomy (PS) of major papilla 8/8-9/10, PS of minor papilla 4/8-1/10, ESWL 2/8-0/10, stones/plugs extraction 8/8-8/10, pancreatic stenting 3/8-1/10. Stents were exchanged in case of pain. ET was technically successful in all patients except one receiving a stent after failure of stones extraction. There were no complications, nor mortality. Follow-up averaged 5.9y (range 4.2-8.5y) in group C and results were “excellent” (n=3) or “good” (n=5). Follow-up averaged 3y (range 0.5-8y) in group T and results were “excellent” (n=8), “good” (n=1) or “fair” (n=1), this last girl undergoing further pancreatico-jejunostomy. Conclusions. ET of severe CP in children and teenagers is effective and safe, providing prolonged relief from symptoms. ET may significantly delay or even avoid surgery. Background. Chronic pancreatitis (CP) may be responsible for pain and vomiting in children. Endotherapy (ET) including ESWL of severe CP with ductal obstruction has shown to be effective and safe in adults. Few data are available for children. Aim. To review immediate and medium-term results of ET for severe CP in children. Patients and Method. 18 children who underwent therapeutic ERCP for symptomatic CP (Jan 91 - Apr 99) were divided in 2 groups according to their age: children (C) (n=8, males n=2, hereditary/idiopathic 4/4, mean age at onset of disease 3.1y, range 1.5- 5.7y, mean age at ET 5y, range 2.4-6.7y) and teenagers (T) (n=10, males n=6, hereditary/idiopathic 0/10, mean age at onset of disease 10y, range 6- 13, mean age at ET 12y, range 9-14). All patients were European, except 2 teenagers from India. ERCP was always performed under general anesthesia in the supine position. The following Olympus duodenoscopes were used: PJF 7.5 (<3y), JF100 (3-4y), and TJF100-140 (>4y). ERCP findings: normal bile ducts 18/18; dilated MPD 18/18, calcified calculi 5/18, MPD stricture 9/18, dominant dorsal duct 4/18. Results were considered: a) “excellent” when no further pain occurred, b) “good” when pain decreased in frequency and intensity but ET was repeated for relapsing symptoms, c) “fair” when immediate results were good but the patient eventually underwent further surgery. Results. The following procedures were performed in the two groups (C-T), respectively: biliary sphincterotomy 8/8-9/10, pancreatic sphincterotomy (PS) of major papilla 8/8-9/10, PS of minor papilla 4/8-1/10, ESWL 2/8-0/10, stones/plugs extraction 8/8-8/10, pancreatic stenting 3/8-1/10. Stents were exchanged in case of pain. ET was technically successful in all patients except one receiving a stent after failure of stones extraction. There were no complications, nor mortality. Follow-up averaged 5.9y (range 4.2-8.5y) in group C and results were “excellent” (n=3) or “good” (n=5). Follow-up averaged 3y (range 0.5-8y) in group T and results were “excellent” (n=8), “good” (n=1) or “fair” (n=1), this last girl undergoing further pancreatico-jejunostomy. Conclusions. ET of severe CP in children and teenagers is effective and safe, providing prolonged relief from symptoms. ET may significantly delay or even avoid surgery.

Endotherapy for chronic pancreatitis.

Endotherapy for chronic pancreatitis.