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World J Gastroenterol. Jan 7, 2013; 19(1): 12-16
Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.12
Is endoscopic therapy the treatment of choice in all patients with chronic pancreatitis?
Beata Jabłońska
Beata Jabłońska, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, 40-752 Katowice, Poland
Author contributions: Jabłońska B wrote this paper.
Correspondence to: Beata Jabłońska, MD, PhD, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, Medyków 14 Street, 40-752 Katowice, Poland.
Telephone: +48-32-7894251 Fax: +48-32-7894251
Received: September 4, 2012
Revised: October 29, 2012
Accepted: November 11, 2012
Published online: January 7, 2013

Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas characterized by destruction of the pancreatic parenchyma with subsequent fibrosis that leads to pancreatic exocrine and endocrine insufficiency. Abdominal pain and local complications (bile duct or duodenal stenosis and pancreatic tumor) secondary to CP are indications for therapy. At the beginning, medical therapy is used. More invasive treatment is recommended for patients with pancreatic duct stones (PDS) and pancreatic obstruction in whom standard medical therapy is not sufficient. Recently, Clarke et al assessed the long-term effectiveness of endoscopic therapy (ET) in CP patients. The authors compared ET with medical treatment. They reported that ET was clinically successful in 50% of patients with symptomatic CP. In this commentary, current CP treatment, including indications for ET and surgery in CP patients, is discussed. Recommendations for endoscopic treatment of CP according to the European Society of Gastrointestinal Endoscopy Clinical Guidelines are reviewed. Different surgical methods used in the treatment of CP patients are also discussed. ET is the most useful in patients with large PDS, pancreatic duct obstruction and dilation. It should be the first-line option because it is less invasive than surgery. Surgery should be the first-line option in patients in whom ET has failed or in those with a pancreatic mass with suspicion of malignancy. ET is a very effective and less invasive procedure, but it cannot be recommended as the treatment of choice in all CP patients.

Keywords: Chronic pancreatitis, Endoscopic therapy, Surgery, Endoscopic retrograde cholangiopancreatography, Endoscopy