Chronic pancreatitis and pancreatic lithiasis. State of the art

Chronic pancreatitis and pancreatic lithiasis, isolated or associated, are infrequent diseases in western countries. They are linked to alcohol abuse, cigarette smoking, repeated episodes of acute pancreatitis and hereditary genetic factors. They are characterised by persistent or recurrent epigastric pain, digestive insufficiency, steatorrhoea, weight loss and secondary dia-betes. They are easily diagnosed with CT and MRI ultrasound, but are difficult to treat. Medical therapy is sympto-matic for diabetes and digestive failure. Invasive treatment is indicated only for pain that cannot be treated otherwise. For lithiasic forms, the therapeutic goal of removing stones can be achieved with shockwave and endoscopy, obtaining fragmentation and extraction of the stones. When this does not happen and these aids have proved ineffective, surgery must be used either as a partial or total resection of the afflicted pancreas, or as a derivation in the intestine of the pancreatic duct dilated and obstructed by Wirsung-jejunal anastomosis. These invasive treatments are effective in 80% of cases, but burdened with complications in 10% and relapses in 5%.