Endoscopic Management of Patients with Chronic Pancreatitis

Chronic pancreatitis (CP) is a common gastrointestinal disease affecting the well-being of most of the patients. Endoscopic treatment has developed as an effective alternative to the surgical therapy through the last two decades. Pain in patients with CP and pancreatic duct stones and strictures can be managed successfully in a subgroup of patients by ESWL, stone extraction and pancreatic duct stenting. The selection of patients or those endoscopic options are not very well defined. Two small randomized studies comparing endoscopic and surgical treatment have shown advantages for the operated group. When the endoscopic treatment attempted is not reducing pain effectively a new interdisciplinary discussion about choosing the proper therapy, e. g. surgical resection of the pancreatic head, should start. Endoscopic stenting of patients with biliary stenosis and cholangitis is the procedure of choice. The long-term results for biliary duct stenosis if only a single plastic stent is used are disappointing. New endoscopic options like multistenting or the use of fully-covered metal stents (fc-SEMS) are promising with success rates close to 80 %. Pseudocyst drainage using endosonography or ERCP can be offered with a high success rate and low complication rates even in standard care circumstances.