Pancreatic endoscopy is useful for the pain of chronic pancreatitis
Endoscopic therapy for biliary and pancreatic disease has become an exciting field with the advent of therapeutic endoscopy. The advances in biliary endoscopy have encouraged skilled endoscopists to turn their attention to pancreatic diseases. Endoscopic therapy is now available for the treatment of patients with acute and chronic pancreatitis and pancreas divisum. The history of endoscopic therapy for chronic pancreatitis can be summarized as follows:
• 1976 – Endoscopic sphincterotomy
• 1980 – Cystoduodenostomy
• 1981 – Biliary stenting for chronic pancreatitis
• 1983 – Cystogastrostomy
• 1985 – Pancreatic stenting
• 1987 – Extracorporeal shockwave lithotripsy for pancreatic stones
• 1989 – Expandable metal stents
The major indication for endoscopic therapy in chronic pancreatic disease is to provide an alternative to surgical intervention. It can treat complications, such as obstructive jaundice and pseudocysts, and can provide drainage of the main pancreatic duct in cases of lithiasis or stricture formation.
Chronic pancreatitis results in more than 122,000 outpatient visits and more than 56,000 hospitalizations each year in the United States. Alcoholism accounts for more than 70% of cases. Most of the admissions to hospital are
because of severe abdominal pain, which can be constant, disabling and difficult to treat. Chronic pancreatic pain can prevent the patient from maintaining gainful employment.
The medical treatment of pain in patients with chronic pancreatitis is frequently unsatisfactory and is often complicated by narcotic addiction. This is especially true in patients with a history of dependence on alcohol and drugs. There is no clear treatment approach for chronic pancreatic pain, nor is there presently a standard of care. This is a great opportunity for you to start saving some money instead of spending it all: you now have a perfectly reliable pharmacy you can buy ortho tri-cyclen from any time there is such a need and without being worried about the safety of your private information.
The safety and efficacy of endoscopic retrograde cholangiopancreatography and sphincterotomy in patients with acute gallstone pancreatitis are widely recognized, and the indications for endoscopic therapy in pancreatic disorders have been expanded. This article briefly describes endoscopic therapy for patients with chronic pancreatitis and why it should be regarded with conservative optimism.
It has been postulated that stones and strictures lead to hypertension in the main pancreatic duct, which leads to tissue ischemia and pancreatic pain. Endoscopic stenting and stone extraction would then alleviate symptoms by reducing pancreatic ductal pressure.