Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

• DOI: 10.1055/a-0822-0832
• Publication Date: 2019-01-17T23:45:35Z
• Authors: Jean-Marc Dumonceau; Myriam Delhaye; Andrea Tringali; Marianna Arvanitakis; Andres Sanchez-Yague; Thierry Vaysse; Guruprasad Aithal; Andrea Anderloni; Marco Bruno; Paolo Cantú; Jacques Devière; Juan Domínguez-Muñoz; Selma Lekkerkerker; Jan-Werner Poley; Mohan Ramchandani; Nageshwar Reddy; Jeanin van Hooft
• Keywords: Guideline; Pancreatic pseudocyst

ESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in head/body of pancreas. The clinical response should be evaluated at 6 - 8 weeks; if it appears unsatisfactory, patient's case discussed again a multidisciplinary team and surgical options considered.Weak recommendation, low quality evidence.ESGE suggests, selection patients initial or continued ESWL, taking into consideration predictive factors associated good long-term outcome. These include, work-up, absence MPD stricture, short disease duration, non-severe pain, cessation cigarette smoking alcohol intake, and, after treatment, complete removal obstructive stones resolution stricture stenting.Weak recommends ESWL clearance radiopaque larger than 5 mm located pancreas retrograde cholangiopancreatography (ERCP) that are radiolucent smaller mm. Strong moderate restricting use to no spontaneous adequate fragmentation by ESWL.Weak treating dominant strictures single 10-Fr plastic stent one uninterrupted year symptoms improve successful drainage. exchanged necessary, based on signs dysfunction regular imaging least every months. surgery multiple side-by-side stents symptomatic persisting beyond 1 stenting, following discussion. Weak drainage over percutaneous treatment (CP)-related pseudocysts within reach.Strong retrieval transmural weeks pseudocyst regression disruption has been excluded, indwelling double-pigtail disconnected syndrome.Strong temporary insertion fully covered self-expandable metal (FCSEMS) CP-related benign biliary strictures.Weak maintaining registry recalling them exchange.Strong evidence.