A number of endoscopic interventions have expanded the range of treatment options
in symptomatic pancreatic diseases. Early endoscopic retrograde cholangiopancreatography
(ERCP) and endoscopic sphincterotomy (ES) appear to be beneficial in patients with
severe acute biliary pancreatitis. Endoscopic pancreatic sphincterotomy can be safely
performed with high technical success rates in patients with chronic pancreatitis.
Routine additional biliary ES or drainage procedures are not apparently necessary.
Stenting can be limited to the treatment of dominant pancreatic duct strictures. In
patients with sphincter of Oddi dysfunction, temporary placement of pancreatic stents
reduces the morbidity associated with ES. Transpapillary or transmural endoscopic
drainage achieves resolution of pancreatic pseudocysts in the majority of selected
patients. Drainage procedures with endoscopic ultrasound guidance can potentially
expand the indications and reduce the procedure-related morbidity. Therapeutic endoscopy
should be considered in symptomatic patients with pancreas divisum, as well as in
selected children with pancreatic diseases. Most of the published studies on therapeutic
pancreatic endoscopy have been conducted retrospectively. Additional prospective controlled
trials are warranted to allow further evaluation of the impact of these methods on
the clinical outcome in comparison with alternative treatment strategies.
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M.D. H. Neuhaus
Medical Dept. Evangelisches Krankenhaus Düsseldorf
40217 Düsseldorf
Germany
Phone: +49-211-919-3960
Email: honeu@rp-plus.de
