Endoscopy 2002; 34(1): 54-62
DOI: 10.1055/s-2002-19391
State of the Art Review

© Georg Thieme Verlag Stuttgart · New York

Therapeutic Pancreatic Endoscopy

H.  Neuhaus1
  • 1Dept. of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
Further Information

Publication History

Submitted

Accepted after Revision

Publication Date:
14 August 2002 (online)

Pharmacological treatment and/or temporary pancreatic stenting can reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography. Potential candidates are patients who are at high risk for this complication. Extensive diagnostic work-up is needed for patients with acute recurrent pancreatitis before treatment can be planned. Endoscopic pancreatic sphincterotomy or temporary stenting, or both, appear to be beneficial in idiopathic recurrent pancreatitis. Short-term stent placement in the dorsal duct, with or without papillotomy of the minor papilla, is a promising approach in patients with symptomatic pancreas divisum, particularly if it is associated with acute recurrent pancreatitis. Endoscopic treatment of chronic obstructive pancreatitis is technically effective and safe, but the indication remains controversial, mainly due to a lack of controlled trials. Endoscopic transmural drainage of pancreatic pseudocysts or abscesses is very effective, and should be considered as a primary approach in symptomatic patients. The endoscopic ultrasonography-guided technique extends the options for obtaining access to fluid collections in difficult locations, and may further increase the safety of the procedure. Many of these procedures are technically demanding, and should be restricted to high-volume centers; there is a continuing need for further evaluation and comparison with alternative strategies.

References

  • 1 Haber G B. Prevention of post-ERCP pancreatitis.  Gastrointest Endosc. 2000;  51 100-103
  • 2 Braganza J M. Towards a novel treatment strategy for acute pancreatitis, 1: reappraisal of the evidence on aetiogenesis.  Digestion. 2001;  63 69-91
  • 3 Braganza J M. Towards a novel treatment strategy for acute pancreatitis, 2: principles and potential practice.  Digestion. 2001;  63 143-162
  • 4 Andriulli A, Leandro G, Niro G. et al . Pharmacologic treatment can prevent pancreatic injury after ERCP: a meta-analysis.  Gastrointest Endosc. 2000;  51 1-7
  • 5 Rabenstein T, Schneider H T, Bulling D. et al . Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.  Endoscopy. 2000;  32 10-19
  • 6 Devière J, Le Moine O, van Laethem J L. et al . Interleukin-10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography.  Gastroenterology. 2001;  120 498-505
  • 7 Tarnasky P R, Palesch Y Y, Cunningham J T. et al . Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction.  Gastroenterology. 1998;  115 1518-1524
  • 8 Aizawa T, Ueno N. Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones.  Gastrointest Endosc. 2001;  54 209-213
  • 9 Bergman J JGHM, Rauws E AJ, Fockens P. et al . Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones.  Lancet. 1997;  349 1124-1129
  • 10 DiSario J A, Freeman M L, Bjorkman D J. et al . Endoscopic balloon dilation vs sphincterotomy (EDES) for bile duct stone removal.  Digestion. 1998;  59 26
  • 11 Fujita N, Maguchi H, Komatsu Y. et al . Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD) for bile duct stones: preliminary report on a randomized controlled trial (abstract).  Gastrointest Endosc. 2001;  53 AB60
  • 12 Goff J S. Long-term experience with the transpancreatic sphincter pre-cut approach to biliary sphincterotomy.  Gastrointest Endosc. 1999;  50 642-645
  • 13 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
  • 14 Khandekar S, DiSario J A. Endoscopic therapy for stenosis of the biliary and pancreatic duct orifices.  Gastrointest Endosc. 2000;  52 500-505
  • 15 Jacob L, Geenen J E, Catalano M F, Geenen D J. Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents.  Endoscopy. 2001;  33 559-562
  • 16 Testoni P A, Caporuscio S, Bagnolo F, Lella F. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment.  Am J Gastroenterol. 2000;  95 1702-1707
  • 17 Baillie J. Idiopathic recurrent pancreatitis: the ERCP Luddites are at the door.  Am J Gastroenterol. 2000;  95 1615-1618
  • 18 Wehrmann T, Schmitt T H, Arndt A. et al . Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction.  Aliment Pharmacol Ther. 2000;  14 1469-1477
  • 19 Wilcox C M, Mönkemüller K F. Wire assisted minor papilla precut papillotomy.  Gastrointest Endosc. 2001;  54 83-86
  • 20 Ertan A. Long-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum.  Gastrointest Endosc. 2000;  52 9-14
  • 21 Boerma D, Huibregtse K, Gulik T M. et al . Long-term outcome of endoscopic stent placement for chronic pancreatitis associated with pancreatic divisum.  Endoscopy. 2000;  32 452-456
  • 22 Etemad B, Whitcomb D C. Chronic pancreatitis: diagnosis, classification, and new genetic developments.  Gastroenterology. 2001;  120 682-707
  • 23 Okolo I II, Pasricha P J, Kalloo A N. What are the long-term results of endoscopic pancreatic sphincterotomy?.  Gastrointest Endosc. 2000;  52 15-19
  • 24 Slivka A, Schoen R E. Endoscopic therapy for pancreatic disease: are we breaking the third rule of surgery?.  Gastrointest Endosc. 2000;  52 134-137
  • 25 Renou C, Grandval P, Ville E, Laugier R. Endoscopic treatment of the main pancreatic duct correlations among morphology, manometry, and clinical follow-up.  Int J Pancreatol. 2000;  27 143-149
  • 26 Schwarz M, Isenmann R, Beger H G. Stenting in chronic pancreatitis: pitfalls and limitations.  Z Gastroenterol. 2000;  38 367-374
  • 27 Brand B, Kahl M, Sidhu S. et al . Prospective evaluation of morphology, function, and quality of life after extracorporeal shock-wave lithotripsy and endoscopic treatment of chronic calcific pancreatitis.  Am J Gastroenterol. 2000;  95 3428-3438
  • 28 Smits M E, Rauws E AJ, van Gulik T M. et al . Long-term results of endoscopic stenting and surgical drainage for biliary stricture due to chronic pancreatitis.  Br J Surg. 1996;  83 764-768
  • 29 Kiehne K, Fölsch U R, Nitsche R. High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis due to noncompliance.  Endoscopy. 2000;  32 377-380
  • 30 Vitale G C, Reed D N, Nguyen C T. et al . Endoscopic treatment of distal bile duct stricture from chronic pancreatitis.  Surg Endosc. 2000;  14 227-231
  • 31 Giovannini M, Pesenti C, Rolland A L. et al . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope.  Endoscopy. 2001;  33 473-477
  • 32 Seifert H, Dietrich C, Schmitt T. et al . Endoscopic ultrasound-guided one-step transmural drainage of cystic abdominal lesions with a large-channel echo endoscope.  Endoscopy. 2000;  32 255-259
  • 33 Inui K, Yoshino J, Okushima K. et al . EUS-guided one-step drainage of pancreatic pseudocysts: experience in 3 patients.  Gastrointest Endosc. 2001;  54 87-89
  • 34 Wiersema M J, Baron T H, Chari S T. Endosonography-guided pseudocyst drainage with a new large-channel linear scanning echoendoscope.  Gastrointest Endosc. 2001;  53 811-813
  • 35 White S A, Sutton C D, Berry D P. et al . Experience of combined endoscopic percutaneous stenting with ultrasound guidance for drainage of pancreatic pseudocysts.  Ann R Coll Surg Engl. 2000;  82 11-15
  • 36 Kim H S, Lee D K, Kim I W. et al . The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury.  Gastrointest Endosc. 2001;  54 49-55
  • 37 Bracher G A, Manocha A P, DeBanto J R. et al . Endoscopic pancreatic duct stenting to treat pancreatic ascites.  Gastrointest Endosc. 1999;  49 710-715
  • 38 Boerma D, Rauws E AJ, van Gullik T M. et al . Endoscopic stent placement for pancreaticocutaneous fistula after surgical drainage of the pancreas.  Br J Surg. 2000;  87 1506-1509
  • 39 Neher J R, Brady P G, Pinkas H, Ramos M. Pancreaticopleural fistula in chronic pancreatitis: resolution with endoscopic therapy.  Gastrointest Endosc. 2000;  52 416-418

H. Neuhaus, M.D.

Dept. of Internal Medicine · Evangelisches Krankenhaus Düsseldorf

Kirchfeldstrasse 40 · 40217 Düsseldorf · Germany

Fax: + 49-211-919-3960

Email: medizinischeklinik@evk-duesseldorf.de