Management of Chronic Pancreatitis

Mapping Intimacies ◽

10.2310/gastro.5466 ◽

2016 ◽

Author(s):

Darwin L. Conwell ◽

Veeral M. Oza

Keyword(s):

Chronic Pancreatitis ◽

Ct Scan ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Clinical Course ◽

Islet Cells ◽

Pain Mechanisms ◽

Computed Tomographic ◽

Future Challenges ◽

Criteria For Diagnosis

Chronic pancreatitis (CP) is a syndrome that is characterized by inflammation, irreversible fibrosis, and loss of acinar and islet cells. It has also been described as an “enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment.” This review describes the epidemiology, diagnosis, diagnostic challenges, differential diagnosis, treatment, complications, and clinical course and prognosis of CP, as well as future challenges. Figures show a computed tomographic (CT) scan of calcific CP, a secretin-enhanced magnetic resonance cholangiopancreatogram showing a dilated and tortuous main pancreatic duct, a CT scan of a large chronic pseudocyst compressing the stomach and pancreas, an endoscopic ultrasound (EUS) image of CP, a retrograde pancreatogram showing a dilated main pancreatic duct with stones and “blunted” side branches, sources of pain in CP, neuropathic pain mechanisms in CP, and an algorithm summarizing treatment of pain in CP. Tables list the TIGAR-O etiologic classification of CP, standard criteria for diagnosis of CP by EUS, Cambridge endoscopic retrograde cholangiopancreatography grading for CP, and a stepwise radiographic and endoscopic diagnostic approach to patients with suspected CP. Key words: bile duct obstruction, chronic pancreatitis, pancreatic calcifications, TIGAR-O system This review contains 8 highly rendered figures, 4 tables, and 54 references.

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Clinical Study of Chronic Pancreatitis with Focal Irregular Narrowing of the Main Pancreatic Duct and Mass Formation: Comparison with Chronic Pancreatitis Showing Diffuse Irregular Narrowing of the Main Pancreatic Duct

Pancreas ◽

10.1097/00006676-200210000-00011 ◽

2002 ◽

Vol 25 (3) ◽

pp. 283-289 ◽

Cited By ~ 51

Author(s):

Tokio Wakabayashi ◽

Yukimitsu Kawaura ◽

Yoshitake Satomura ◽

Tomoharu Fujii ◽

Yoshiharu Motoo ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Clinical Study ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Mass Formation

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Defining the endoscopic ultrasound features of chronic pancreatitis in Asians: a multicenter validation study

Endoscopy ◽

10.1055/a-1217-3112 ◽

2020 ◽

Cited By ~ 1

Author(s):

Calvin Jianyi Koh ◽

Sundeep Lakhtakia ◽

Mitsuhiro Kida ◽

Cosmas Rinaldi A. Lesmana ◽

Tiing Leong Ang ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Main Pancreatic Duct ◽

Cross Sectional Study ◽

Cancer Surveillance ◽

Receiver Operating Curve ◽

Cross Sectional ◽

Multicenter Prospective Study ◽

Ultrasound Features

Background Although endoscopic ultrasound (EUS) features and criteria have been described in chronic pancreatitis, challenges remain with interoperator variability and ease of adoption. The aim of this study was to define and validate the EUS features of chronic pancreatitis in a multicenter prospective study in Asia. Method The study was divided into two parts: the first part was conducted to derive the EUS features of chronic pancreatitis with adequate interoperator agreement; the second was to prospectively evaluate these features in a multicenter cross-sectional study and determine the optimal combination of features for the diagnosis of chronic pancreatitis. Prospectively enrolled cases had standard internationally validated radiologic or histologic features of chronic pancreatitis, and controls were patients without chronic pancreatitis who underwent EUS examination. Results The top six EUS features that had good interobserver agreement (mean kappa 0.73, range 0.60 – 0.90) were selected to be further evaluated in part II of the study. These included: hyperechoic foci with shadowing, lobularity with honeycombing, cysts, dilated main pancreatic duct, dilated side branches, and calculi in the main pancreatic duct. A total of 284 subjects (132 cases, 152 controls) were enrolled from 12 centers in Asia. All six features had high accuracy ranging from 63.3 % to 89.1 %. Two or more of these six EUS features accurately defined chronic pancreatitis (sensitivity 94.7 %, specificity 98.0 %), with an area under the receiver operating curve of 0.986. Conclusion This multicenter Asian study characterized and defined the EUS features of chronic pancreatitis. This provides a useful tool in clinical practice and further research in pancreatic cancer surveillance.

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Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

Journal of Morphological Sciences ◽

10.1055/s-0039-1698371 ◽

2019 ◽

Vol 36 (04) ◽

pp. 279-285

Author(s):

Mythraeyee Prasad ◽

Sipra Rout ◽

Tharani Putta ◽

Reuben Thomas Kurien ◽

Sudipta Dhar Chowdhury ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Magnetic Resonance ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Pancreas Divisum ◽

Magnetic Resonance Cholangiopancreatography ◽

Radiological Study ◽

Ductal System ◽

Type Iii ◽

Ansa Pancreatica

Abstract Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In the cadaveric study, the main pancreatic duct was single with a straight course in 46.67% of the adult specimens, and in the MRCP study, the main pancreatic duct showed a descending course in 77.66% of the cases. The most common pattern was type III in both the cadaveric (80%) and radiological (55.33%) studies, and the accessory duct was absent on the MRCP in all type-III cases, while it ended blindly in the cadaveric specimens. Ansa pancreatica (type V) was observed in 1 adult specimen (6.7%), but not in the radiological study. Pancreas divisum (type IV) was observed in the 8 cases (7.76%) cases in the radiological study. Conclusion Knowledge of the anatomical variants of the pancreatic ductal system may be helpful for the radiologists during diagnostic and therapeutic interventional procedures.

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The Timing of ERCP After Extracorporeal Shock Wave Lithotripsy for Chronic Pancreatitis is Critical for Clearance of Main Pancreatic Duct Stones

The American Journal of Gastroenterology ◽

10.14309/00000434-200910003-00221 ◽

2009 ◽

Vol 104 ◽

pp. S85

Author(s):

Joseph Merrill ◽

Riad Azar ◽

Daniel Mullady ◽

Steven Edmundowicz ◽

Sreeni Jonnalagadda

Keyword(s):

Shock Wave ◽

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Extracorporeal Shock Wave Lithotripsy ◽

Main Pancreatic Duct ◽

Shock Wave Lithotripsy ◽

Extracorporeal Shock Wave ◽

Pancreatic Duct Stones

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ERCP in Evaluating The Mode of Therapy in Pancreatic Pseudocyst

HPB Surgery ◽

10.1155/1988/47060 ◽

1988 ◽

Vol 1 (1) ◽

pp. 35-44 ◽

Cited By ~ 7

Author(s):

I. Nordback ◽

O. Auvinen ◽

I. Airo ◽

J. Isolauri ◽

O. Teerenhovi

Keyword(s):

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Main Pancreatic Duct ◽

Pancreatic Pseudocyst ◽

Treatment Method ◽

Internal Drainage ◽

Endoscopic Retrograde ◽

External Drainage ◽

Computed Tomographic ◽

Pancreatic Resections

Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stensosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage.

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