Therapeutic Pancreatic Endoscopy

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.

References

• 1 Sugiyama M, Atomi Y. Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography.  Surgery. 1998;  124 14-21
• 2 Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones.  Lancet. 1988;  ii 979-983
• 3 Fan ST, Lai ECS, Mok FPT, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy.  N Engl J Med. 1993;  328 228-232
• 4 Nowak A, Nowakowska-Dulawa E, Marek T, et al. Final results of the prospective, randomized, controlled study on endoscopic sphincterotomy versus conventional management in acute biliary pancreatitis [abstract].  Gastroenterology. 1995;  108 380
• 5 Fölsch UR, Nitsche R, Ludtke R, et al. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis.  N Engl J Med. 1997;  336 237-242
• 6 Pezzilli R, Billi P, Barakat B, et al. Effects of early ductal decompression in human biliary acute pancreatitis.  Pancreas. 1998;  16 165-168
• 7 Rünzi M, Saluja A, Lerch MM, et al. Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum.  Gastroenterology. 1993;  105 157-164
• 8 Hammarstrom LE, Andersson R, Stridbeck, et al. Influence of bile duct stones on patient features and effect of endoscopic sphincterotomy on early outcome of edematous gallstone pancreatitis.  World J Surg. 1999;  23 12-17
• 9 Sherman S, Lehman GA. Endoscopic pancreatic sphincterotomy: techniques and complications.  Gastrointest Endosc Clin N Am. 1998;  8 115-124
• 10 Ell C, Rabenstein T, Schneider HT, et al. Safety and efficacy of pancreatic sphincterotomy in chronic pancreatitis.  Gastrointest Endosc. 1998;  48 244
• 11 Elton E, Howell DA, Parsons WG, et al. Endoscopic pancreatic sphincterotomy: indications, outcome and a safe stentless technique.  Gastrointest Endosc. 1998;  47 240-249
• 12 Kim MH, Myung SJ, Kim YS, et al. Routine biliary sphincterotomy may not be indispensable for endoscopic pancreatic sphincterotomy.  Endoscopy. 1998;  30 697-701
• 13 Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.  Gastroenterology. 1998;  115 1518-1524
• 14 Hogan WJ. Stenting the pancreas: is this the solution to post-ERCP pancreatitis?.  Gastroenterology. 1998;  115 1591-1594
• 15 Binmoeller KF, Rathod VD, Soehendra N. Endoscopic therapy of pancreatic strictures.  Gastrointest Endosc Clin N Am. 1998;  8 125-142
• 16 Ikenberry SO, Sherman S, Hawes RH, et al. The occlusion rate of pancreatic stents.  Gastrointest Endosc. 1994;  40 611-613
• 17 Reber PU, Patel AG, Lewis MP, et al. Stenting does not decompress the pancreatic duct as effectively as surgery in experimental chronic pancreatitis.  Surgery. 1998;  124 561-567
• 18 Laugier R, Renou C. Endoscopic ductal drainage may avoid resective surgery in painful chronic pancreatitis without large ductal dilatation.  Int J Pancreatol. 1998;  23 145-152
• 19 Ziebert JJ, DiSario JA. Dilation of refractory pancreatic duct strictures: the turn of the screw.  Gastrointest Endosc. 1999;  49 632-635
• 20 Brand B, Thonke F, Obytz S, et al. Stent retriever for dilation of pancreatic and bile duct strictures.  Endoscopy. 1999;  31 142-145
• 21 Lahoti S, Catalano MF, Geenen JE, et al. Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center.  Gastrointest Endosc. 1998;  47 486-491
• 22 Eisendrath P, Devière J. Expandable metal stents for benign pancreatic duct obstruction.  Gastrointest Endosc Clin N Am. 1999;  9 547-554
• 23 Howell DA, Elton E, Parsons WG. Endoscopic management of peudocysts of the pancreas.  Gastrointest Endosc Clin N Am. 1998;  8 142-162
• 24 Giovannini M, Bernardini D, Seitz JF. Cystogastrotomy entirely performed under endosonography guidance for pancreatic pseudocyst: results in six patients.  Gastrointest Endosc. 1998;  48 200-203
• 25 Vilmann P, Hancke S, Pless T, et al. One-step endosonography-guided drainage of a pancreatic pseudocyst: a new technique of stent delivery through the echo endoscope.  Endoscopy. 1998;  30 730-733
• 26 Monkemuller KE, Baron TH, Morgan DE. Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique.  Gastrointest Endosc. 1998;  48 195-200
• 27 Beckingham IJ, Krige JE, Bornman PC, Terblanche J. Long-term outcome of endoscopic drainage of pancreatic.  Am J Gastroenterol. 1999;  94 71-74
• 28 Kozarek RA. Endoscopic therapy of complete and partial pancreatic duct disruptions.  Gastrointest Endosc Clin N Am. 1998;  8 39-53
• 29 Bracher GA, Manocha AP, DeBanto JR, et al. Endoscopic pancreatic duct stenting to treat pancreatic ascites.  Gastrointest Endosc. 1999;  49 710-715
• 30 Holst T, Grille W, Asbeck F. Endoscopic therapy of a pancreatic effusion caused by chronic pancreatitis.  Z Gastroenterol. 1998;  36 893-896
• 31 Hastier P, Rouquier B, Buckley M, et al. Endoscopic treatment of wirsungo-cysto-pleural fistula.  Eur J Gastroenterol Hepatol. 1998;  10 527-529
• 32 Uomo G, Molino D, Visconti M, et al. The incidence of main pancreatic duct disruption in severe biliary pancreatitis.  Am J Surg. 1998;  176 49-52
• 33 Dinu F, Devière J, Van Gossum A, et al. The wirsungorrhagies: causes and management in 14 patients.  Endoscopy. 1998;  30 595-600
• 34 Lehman GA, Sherman S. Diagnosis and therapy of pancreas divisum.  Gastrointest Endosc Clin N Am. 1998;  8 55-77
• 35 Jacob L, Geenen JE, Catalano MF, et al. Clinical presentation and short-term outcome of endoscopic therapy of patients with symptomatic incomplete pancreas divisum.  Gastrointest Endosc. 1999;  49 53-57
• 36 Guelrud M. Endoscopic therapy of pancreatic disease in children.  Gastrointest Endosc Clin N Am. 1998;  8 195-219
• 37 Graham KS, Ingram JD, Steinberg SE, et al. ERCP in the management of pediatric pancreatitis.  Gastrointest Endosc. 1998;  47 492-495
• 38 Neuhaus H, Schumacher B. Miniscopes.  Baillière's Clin Gastroenterol. 1999;  13 33-48
• 39 Kaneko T, Nakao A, Nomoto S, et al. Intraoperative pancreatoscopy with the ultrathin pancreatoscope fur mucin-producing tumors of the pancreas.  Arch Surg. 1998;  133 263-267
• 40 Kodama T, Sato H, Horii Y, et al. Pancreatoscopy for the next generation: development of the peroral electronic pancreatoscope system.  Gastrointest Endosc. 1999;  49 366-371
• 41 Craigie JE, Adams DB Byme TK, et al. Endoscopic electrohydraulic lithotripsy in the management of pancreatobiliary lithiasis.  Surg Endosc. 1998;  12 405-408