Endoscopic Management of Chronic Pancreatitis

Chronic pancreatitis (CP) is a progressive fibroinflammatory disease characterized by pancreatic ductal obstruction, calcification, and fibrosis, leading to chronic pain and exocrine or endocrine insufficiency. Endoscopic management plays a central role in selected patients with painful obstructive CP, providing ductal decompression and drainage while avoiding the morbidity of surgery. Endoscopic retrograde cholangiopancreatography with pancreatic sphincterotomy, stenting, and stone extraction is the mainstay of therapy. Extracorporeal shock wave lithotripsy or pancreatoscopy-guided lithotripsy is recommended for radiopaque or large main pancreatic duct stones, whereas a single large-caliber plastic stent has been suggested for dominant ductal strictures. An endoscopic ultrasound guided celiac plexus block may be considered in patients with refractory pain unresponsive to medical or endoscopic therapy, even though its effect is usually transient. Endoscopic drainage is preferred over surgical or percutaneous approaches for uncomplicated pancreatic pseudocysts. A multidisciplinary approach involving endoscopists, surgeons, and pain specialists is essential, and early surgical consultation should be considered when endoscopic therapy fails or when complete ductal clearance is unlikely. This review summarizes current evidence and international guideline recommendations on the role of endoscopy in the management of chronic pancreatitis.