Chronic pancreatitis

Article Abstract:

The diagnosis and treatment of chronic pancreatitis continues to pose medical challenges. Abdominal pain, blocked ducts, small stones, fibrous and inflamed tissues may be present in chronic pancreatitis. The causes of chronic pancreatitis are not fully understood but heavy alcohol use by men may be one factor. Diagnostic difficulties include detecting pancreatitis in the absence of imaging results and distinguishing between pancreatitis and pancreatic cancer. A variety of diagnostic tools is available but fails to detect early stages of the disease. Treatment options must address pain, dilated ducts, and stones in the pancreatic ducts. Noninvasive pain management includes narcotics and digestive enzymes. Enzymes are thought to eliminate pain by blocking pancreatic secretion. Therapeutic results are mixed at best, however. Dilated ducts may be drained to relieve pain but the effects may not last. Surgery of the pancreas should be a last resort.

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Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis

Article Abstract:

Endoscopic examination of the ampulla of Vater, pancreas, liver, and bile ducts and surgery to remove gallstones because of pancreatic inflammation may not increase survival. Researchers compared the outcomes of patients with acute biliary inflammation of the pancreas by treating 112 patients conservatively by observing them carefully, and treating 126 patients with early endoscopic examination of the pancreatic region using radiographic contrast medium (ERCP) and with surgery to remove gallstones. Fourteen patients in the ERCP group and seven in the conservatively treated group died within three months. ERCP patients had more serious complications.

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Treatment of acute biliary pancreatitis

Article Abstract:

Routine endoscopic evaluation of the pancreas and related ducts in the presence of pancreatic inflammation may not be advisable before surgery to remove gallstones. A German study comparing conservative treatment of acute biliary pancreatic inflammation to endoscopic procedures to explore and allow gallstones to pass showed that more serious complications, particularly breathing problems, were associated with the endoscopic treatment group. Endoscopic treatment of pancreatitis has gained favor since a 1988 study endorsed it. The technical skill of endoscopists may vary too much from hospital to hospital to recommend it routinely.

Editorial

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