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.
References
1
Haber G B.
Prevention of post-ERCP pancreatitis.
Gastrointest Endosc.
2000;
51
100-103
4
Andriulli A, Leandro G, Niro G. et al .
Pharmacologic treatment can prevent pancreatic injury after ERCP: a meta-analysis.
Gastrointest Endosc.
2000;
51
1-7
5
Rabenstein T, Schneider H T, Bulling D. et al .
Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.
Endoscopy.
2000;
32
10-19
6
Devière J, Le Moine O, van Laethem J L. et al .
Interleukin-10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography.
Gastroenterology.
2001;
120
498-505
7
Tarnasky P R, Palesch Y Y, Cunningham J T. et al .
Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.
Gastroenterology.
1998;
115
1518-1524
8
Aizawa T, Ueno N.
Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones.
Gastrointest Endosc.
2001;
54
209-213
9
Bergman J JGHM, Rauws E AJ, Fockens P. et al .
Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones.
Lancet.
1997;
349
1124-1129
10
DiSario J A, Freeman M L, Bjorkman D J. et al .
Endoscopic balloon dilation vs sphincterotomy (EDES) for bile duct stone removal.
Digestion.
1998;
59
26
11
Fujita N, Maguchi H, Komatsu Y. et al .
Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) for bile duct stones: preliminary report on a randomized controlled trial (abstract).
Gastrointest Endosc.
2001;
53
AB60
15
Jacob L, Geenen J E, Catalano M F, Geenen D J.
Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents.
Endoscopy.
2001;
33
559-562
16
Testoni P A, Caporuscio S, Bagnolo F, Lella F.
Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment.
Am J Gastroenterol.
2000;
95
1702-1707
18
Wehrmann T, Schmitt T H, Arndt A. et al .
Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction.
Aliment Pharmacol Ther.
2000;
14
1469-1477
20
Ertan A.
Long-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum.
Gastrointest Endosc.
2000;
52
9-14
21
Boerma D, Huibregtse K, Gulik T M. et al .
Long-term outcome of endoscopic stent placement for chronic pancreatitis associated with pancreatic divisum.
Endoscopy.
2000;
32
452-456
25
Renou C, Grandval P, Ville E, Laugier R.
Endoscopic treatment of the main pancreatic duct correlations among morphology, manometry, and clinical follow-up.
Int J Pancreatol.
2000;
27
143-149
27
Brand B, Kahl M, Sidhu S. et al .
Prospective evaluation of morphology, function, and quality of life after extracorporeal shock-wave lithotripsy and endoscopic treatment of chronic calcific pancreatitis.
Am J Gastroenterol.
2000;
95
3428-3438
28
Smits M E, Rauws E AJ, van Gulik T M. et al .
Long-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis.
Br J Surg.
1996;
83
764-768
29
Kiehne K, Fölsch U R, Nitsche R.
High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance.
Endoscopy.
2000;
32
377-380
30
Vitale G C, Reed D N, Nguyen C T. et al .
Endoscopic treatment of distal bile duct stricture from chronic pancreatitis.
Surg Endosc.
2000;
14
227-231
31
Giovannini M, Pesenti C, Rolland A L. et al .
Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope.
Endoscopy.
2001;
33
473-477
32
Seifert H, Dietrich C, Schmitt T. et al .
Endoscopic ultrasound-guided one-step transmural drainage of cystic abdominal lesions with a large-channel echo endoscope.
Endoscopy.
2000;
32
255-259
33
Inui K, Yoshino J, Okushima K. et al .
EUS-guided one-step drainage of pancreatic pseudocysts: experience in 3 patients.
Gastrointest Endosc.
2001;
54
87-89
34
Wiersema M J, Baron T H, Chari S T.
Endosonography-guided pseudocyst drainage with a new large-channel linear scanning echoendoscope.
Gastrointest Endosc.
2001;
53
811-813
35
White S A, Sutton C D, Berry D P. et al .
Experience of combined endoscopic percutaneous stenting with ultrasound guidance for drainage of pancreatic pseudocysts.
Ann R Coll Surg Engl.
2000;
82
11-15
36
Kim H S, Lee D K, Kim I W. et al .
The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury.
Gastrointest Endosc.
2001;
54
49-55
37
Bracher G A, Manocha A P, DeBanto J R. et al .
Endoscopic pancreatic duct stenting to treat pancreatic ascites.
Gastrointest Endosc.
1999;
49
710-715
38
Boerma D, Rauws E AJ, van Gullik T M. et al .
Endoscopic stent placement for pancreaticocutaneous fistula after surgical drainage of the pancreas.
Br J Surg.
2000;
87
1506-1509
