07 Jul

Pancreatic endoscopy is useful for the pain of chronic pancreatitis: PANCREATIC PSEUDOCYSTS (Part 2)

transpapillary, cystogastrostomy and cystoduodenostomy

The success rates with transpapillary, cystogastrostomy and cystoduodenostomy approaches were 46%, 21% and 33%, respectively. Complication rates were as high as 17% (most of these involved bleeding), and 1% of patients died. It is important to appreciate that pseudocysts should be considered for drainage only if they are symptomatic, are causing complications or are enlarging.

These preliminary reports are interesting, but there have been no randomized comparative studies to date of different treatment modalities for pseudocysts. Most centres use the technique with which they have the most experience.

In conclusion, endoscopic therapy is a nonsurgical approach to the management of chronic pancreatitis. This new and exciting technology has shown some promising results in several case series. It is my opinion that it should be regarded with conservative optimism. Unfortunately, there have been no controlled comparison studies of endoscopic versus surgical or radiological intervention. The position statement of the American Gastroenterological Association is accurate when it states that no guidelines have yet been published that validate most endoscopic modalities. This would require blinded, prospective, controlled trials that include assessment of abdominal pain and quality of life measures. Your turn to find out more about the possibility to get prednisone online and pay tons less.

Key point

The evidence supporting the use of endoscopic therapy for pain in chronic pancreatitis is preliminary and largely confined to short term focus observations. These procedures require further evaluation in clinical trials.

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