ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team

Video Transcription

Video Summary

Dr. Rohit Agrawal discussed pancreatic endotherapy for chronic pancreatitis, emphasizing that the key is selecting the right patient and matching therapy to the main pain mechanism: “plumbing” problems from duct obstruction versus “wiring” problems from nerve sensitization. He reviewed diagnosis with CT, MRCP, secretin MRCP, and EUS, and outlined management including lifestyle changes, nutrition, endocrine/exocrine insufficiency, and pain control.<br /><br />For obstructive, calcific disease with a dilated pancreatic duct, endoscopic options include sphincterotomy, stenting, stricture dilation, stone extraction, pancreatoscopy with EHL or laser lithotripsy, and extracorporeal shockwave lithotripsy (ESWL). Surgical options include drainage and resection procedures. He highlighted trial data suggesting surgery often outperforms endoscopy overall, but outcomes are similar when endoscopy achieves complete duct clearance. Therefore, complete stone clearance is central to success.<br /><br />He recommended surgery first for suitable candidates, but endotherapy is appropriate when surgery is contraindicated or if the patient prefers it, especially in centers with expertise. For pancreatic strictures, plastic stents are preferred over metal stents. For stones, treatment depends on size, location, and radiopacity. He also stressed managing expectations: pain relief is often partial, not complete, and reinterventions are common.

Keywords

chronic pancreatitis

pancreatic endotherapy

duct obstruction

pancreatic duct stones

MRCP

ESWL

surgical drainage