Endoscopic Treatment of Calcifying Chronic Pancreatitis: Trick or Treatment?

Abstract

In the treatment of chronic calcifying pancreatitis (CCP), endoscopy can be proposed in certain circumstances. Endoscopic treatment is useful in treating local complications such as pancreatic pseudocysts and biliary strictures. Endotherapy is also effective in treating postsurgical complications such as pancreatic leakage after pancreatic resection, or anastomotic strictures occurring after pancreatico-jejunostomy. The main indication for endotherapy is to control painful CCP resistant to medical treatment, or recurrent attacks of acute pancreatitis which frequently appear in the course of CCP. This goal can be achieved by endoscopic drainage procedures in cases of outflow obstruction caused by pancreatic ductal stones, strictures of the main duct, or a compressing pseudocyst, all resulting in upstream dilation. These drainage procedures include pancreatic sphincterotomy stone extraction, balloon dilation of strictures, usually followed by stent insertion, and pseudocyst drainage. Many papers have been published on the treatment of painful CCP, but we lack objective parameters for improvement, and the follow-up period is not long enough for a chronic benign disease in most series. Finally, the question of whether the long-term result will prove to be better or worse than what has been achieved in the past by medical therapy or surgical intervention for CCP is still controversial.