Advanced Endoscopy Fellows Program | September 2022-Singh

Singh_Pancreatic Case

Pdf Summary

The document discusses various cases of chronic pancreatitis and the management options for pancreatic duct strictures and stones. <br /><br />One case involves a 50-year-old male with a history of large cell lymphoma, biliary obstruction, and chronic pancreatitis. He presented with septic shock and was referred for evaluation. The recommended approach was surgical pancreatico-jejunostomy or an endoscopic approach. The importance of considering the size of the stone, size of the duct downstream, presence of stricture or mass, and having a backup plan was emphasized.<br /><br />Another case described a 37-year-old male with alcohol-related acute pancreatitis and multiple admissions for acute on chronic pancreatitis. The management involved EUS-guided drainage and follow-up.<br /><br />The complications of chronic pancreatitis, specifically pancreatic duct strictures, were discussed. Options for endotherapy (ERCP, EUS-guided drainage, surgical drainage) and the use of metal stents were mentioned. The success rates, complications, and recommendations for stent size and duration were also mentioned.<br /><br />The document also discussed the approach to pancreatic duct stones, including the use of ESWL, endotherapy options (sphincterotomy, lithotripsy, stone removal), and the criteria for considering endotherapy without ESWL.<br /><br />Surgical options for chronic pancreatitis, such as decompression, resection, and total pancreatectomy, were mentioned. The pros and cons of endotherapy versus surgery were discussed, along with the findings of relevant clinical trials.<br /><br />Overall, the document provides insight into the management of chronic pancreatitis, specifically focusing on pancreatic duct strictures and stones. The importance of individualized approaches and considering factors such as patient preferences, co-morbidities, and follow-up was emphasized.

Keywords

chronic pancreatitis

pancreatic duct strictures

pancreatic stones

surgical pancreatico-jejunostomy

endoscopic approach

EUS-guided drainage

metal stents

ESWL

endotherapy

clinical trials