ASGE Annual Postgraduate Course Endoscopy 2022: Breakthrough to Excellence | DDW 2022-Shah_ASGE PG Course Endoscopic Management of CP

Shah_ASGE PG Course Endoscopic Management of CP

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This document discusses the use of endotherapy in the management of chronic pancreatitis and highlights the impact it can have on patient outcomes. The author emphasizes the importance of determining the underlying cause of pancreatitis, cessation of alcohol and tobacco, and considering the patient's motivation to minimize or avoid narcotics.<br /><br />The document also discusses the use of endoscopy for symptomatic strictures in chronic pancreatitis or pseudocysts. The guidelines suggest using stents for one year, followed by fully covered self-expandable metal stents (FCSEMS) if the stricture persists. Transmural drainage is recommended for pseudocysts, with long-term plastic stents if the pancreatic duct is disconnected.<br /><br />The author shares a case of a 64-year-old female smoker with a pancreatic duct stricture in the head, whose symptoms improved with stent placement. However, at 4 months, there was a ductal cutoff at the upstream end of the FCSEMS, and the patient experienced recurrent pain. The author advises against using FCSEMS in the pancreatic duct.<br /><br />The document also discusses the management of pancreatic stones, which can cause increased pressure and obstructive symptoms. Fragmentation of stones is often required, and options include extracorporeal shock wave lithotripsy (ESWL) or intraductal therapy. The guidelines recommend ESWL as the first-line treatment for obstructed main pancreatic duct stones, with ERCP for smaller or radiolucent stones.<br /><br />In the case presented in the document, the patient had multiple calcifications. The author suggests considering endoscopic ultrasonography (EUS) guided cystogastrostomy with pancreas-preserving pancreaticojejunostomy (POP) for pancreatic duct stones if endotherapy and neuromodulators are ineffective and the patient is motivated to minimize narcotics.<br /><br />Overall, the document emphasizes the importance of individualized management approaches in chronic pancreatitis and highlights the role of endotherapy in improving patient outcomes.

Keywords

endotherapy

chronic pancreatitis

patient outcomes

alcohol cessation

tobacco cessation

endoscopy

stents

pancreatic duct

pancreatic stones

individualized management