John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Role of interventional endoscopy for the management of chronic calcifying pancreatitis Volume 23, issue 10, Décembre 2016


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CHU Rangueil, service de gastro-entérologie et nutrition, pôle digestif, 1 avenue Jean Poulhès – TSA, 50032, 31059 Toulouse - Cédex 9, France
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Interventional endoscopy plays an important role in the treatment of pain and complications of chronic calcifying pancreatitis. The indications must be discussed among a multidisciplinary team of specialized centres in bilio-pancreatic endoscopy and after relevant clinical and radiological investigations searching for co-mobidities and pancreatic lesions. Endoscopy (ERCP and interventional EUS) is not dissociable from medical treatment of chronic pancreatitis that includes alcohol and tobacco withdrawal as well as exocrine and endocrine function substitution. In painful patients with pancreatic duct stricture, a 10 French plastic stent should be placed and let in place 12 months (including stent replacement every 3 months). A sustained pain relief can be thus obtained in 75% of cases. In biliary obstruction complicating chronic pancreatitis, temporary placement of multiple plastic stents is proposed over a 12-month period. However, full covered self-expandable metal stents give similar results with a reduced risk of obstruction and less ERCP procedures. The success of long-term common bile duct calibration is obtained in near 80% of cases. In case of initial or secondary failure of endoscopic procedures, surgery should be applied with wirsungo-jejunal or hepatico-jejunal bypass (15 to 20% of cases). Pseudocysts with symptoms should be treated by a transmural procedure under endoscopic ultrasound inserting one or two double pig tail plastic stents let in place at least two months. A long-term success is obtained in 80 to 90% of cases. In all cases, a failure or an absence of long-term positive results must led to a multidisciplinary decision toward another therapeutic option including surgery.