Kaufman M, Singh G, Das S, et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010 Feb. 44(2):127-34. [QxMD MEDLINE Link].
Gadroy FX, Ponchon T, Roda R, et al. Endoscopic treatment of chronic pancreatitis: long-term results. Gastrointest Endosc. Apr 2006. 63(5):AB312.
Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007 Feb 15. 356(7):676-84. [QxMD MEDLINE Link].
[Guideline] Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol. 2016 Feb. 51 (2):85-92. [QxMD MEDLINE Link].
Buchler MW, Martignoni ME, Friess H, Malfertheiner P. A proposal for a new clinical classification of chronic pancreatitis. BMC Gastroenterol. 2009 Dec 14. 9:93. [QxMD MEDLINE Link]. [Full Text].
Pezzilli R. Etiology of chronic pancreatitis: has it changed in the last decade?. World J Gastroenterol. 2009 Oct 14. 15(38):4737-40. [QxMD MEDLINE Link]. [Full Text].
Kawa S, Hamano H, Ozaki Y, et al. Long-term follow-up of autoimmune pancreatitis: characteristics of chronic disease and recurrence. Clin Gastroenterol Hepatol. 2009 Nov. 7(11 Suppl):S18-22. [QxMD MEDLINE Link].
Schmitt F, Le Henaff G, Piloquet H, et al. Hereditary pancreatitis in children: surgical implications with special regard to genetic background. J Pediatr Surg. 2009 Nov. 44(11):2078-82. [QxMD MEDLINE Link].
Ooi CY, Dorfman R, Cipolli M, et al. Type of CFTR mutation determines risk of pancreatitis in patients with cystic fibrosis. Gastroenterology. 2011 Jan. 140(1):153-61. [QxMD MEDLINE Link].
Tezuka K, Makino T, Hirai I, Kimura W. Groove pancreatitis. Dig Surg. 2010. 27(2):149-52. [QxMD MEDLINE Link].
[Guideline] Parniczky A, Abu-El-Haija M, Husain S, et al. EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis. Pancreatology. 2018 Mar. 18 (2):146-60. [QxMD MEDLINE Link].
[Guideline] Frokaer JB, Akisik F, Farooq A, et al, for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. Guidelines for the diagnostic cross sectional imaging and severity scoring of chronic pancreatitis. Pancreatology. 2018 Oct. 18 (7):764-73. [QxMD MEDLINE Link].
Hafezi-Nejad N, Singh VK, Johnson SI, et al. Surgical approaches to chronic pancreatitis: indications and imaging findings. Abdom Radiol (NY). 2016 Oct. 41(10):1980-96. [QxMD MEDLINE Link].
Saftoiu A, Popescu C, Cazacu S, et al. Power Doppler endoscopic ultrasonography for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis. J Ultrasound Med. 2006 Mar. 25(3):363-72. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Drewes AM, Bouwense SAW, Campbell CM, et al, for the Working Group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology. 2017 Sep - Oct. 17 (5):720-31. [QxMD MEDLINE Link].
[Guideline] Vege SS, Ziring B, Jain R, Moayyedi P, for the Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015 Apr. 148(4):819-22. [QxMD MEDLINE Link].
Kalb B, Martin DR, Sarmiento JM, et al. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology. 2013 Nov. 269(2):475-81. [QxMD MEDLINE Link].
Hart PA, Levy MJ, Smyrk TC, et al. Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis): the Mayo Clinic experience. Gut. 2016 Oct. 65(10):1702-9. [QxMD MEDLINE Link].
Saito N, Suzuki M, Sakurai Y, et al. Genetic analysis of Japanese children with acute recurrent and chronic pancreatitis. J Pediatr Gastroenterol Nutr. 2016 Oct. 63(4):431-6. [QxMD MEDLINE Link].
da Costa MZ, Pires JG, Nasser PD, et al. Frequency of tabagism and N34S and P55S mutations of serine peptidase inhibitor, Kazal type 1 (SPINK1) and R254W mutation of chymotrypsin C (CTRC) in patients with chronic pancreatitis and controls. Pancreas. 2016 Oct. 45(9):1330-5. [QxMD MEDLINE Link].
Palermo JJ, Lin TK, Hornung L, et al. Genophenotypic analysis of pediatric patients with acute recurrent and chronic pancreatitis. Pancreas. 2016 Oct. 45(9):1347-52. [QxMD MEDLINE Link].
Pezzilli R, Melzi dʼEril G, Barassi A. Can serum pancreatic amylase and lipase levels be used as diagnostic markers to distinguish between patients with mucinous cystic lesions of the pancreas, chronic pancreatitis, and pancreatic ductal adenocarcinoma?. Pancreas. 2016 Oct. 45(9 suppl 1):1272-5. [QxMD MEDLINE Link].
Kapural L, Jolly S. Interventional pain management approaches for control of chronic pancreatic pain. Curr Treat Options Gastroenterol. 2016 Sep. 14(3):360-70. [QxMD MEDLINE Link].
Kwon CI, Kim HJ, Korc P, et al. Can we detect chronic pancreatitis with low serum pancreatic enzyme levels?. Pancreas. 2016 Sep. 45(8):1184-8. [QxMD MEDLINE Link].
[Guideline] Dominguez-Munoz JE, Drewes AM, Lindkvist B, et al, for the HaPanEU/UEG Working Group. Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. Pancreatology. 2018 Dec. 18(8):847-54. [QxMD MEDLINE Link].

Media Gallery

This endoscopic retrograde cholangiopancreatography (ERCP) shows advanced chronic pancreatitis. The pancreatogram has blunting of the lateral branches, dilation of the main pancreatic duct, and filling defects consistent with pancreatolithiasis. The cholangiogram also shows a stenosis of the distal bile duct and a dilated biliary tree.
Chronic pancreatitis. Abdominal CT scan showing a pancreatic pseudocyst causing distortion of the ductal system.
This patient has recurrent abdominal pain. She used alcohol heavily in the past and was involved in a motor vehicle accident. The pancreatogram shows subtle blunting of the side branches consistent with chronic pancreatitis. A stricture also is present in the body of the pancreas where it drapes over the spine, probably resulting from the trauma she sustained in the motor vehicle accident. Air in the stomach makes it difficult to observe that contrast is filling a pseudocyst on the other side of the stricture. These findings are not amenable to endoscopic intervention, and the patient was sent for a distal pancreatectomy.
Chronic pancreatitis. This magnetic resonance cholangiopancreatography (MRCP) shows a healthy biliary system. The pancreatic ductal system is not well visualized. A subsequent endoscopic retrograde cholangiopancreatography (ERCP [not pictured]) showed pancreas divisum, with no evidence of a communication with the pseudocyst. The endoscopic features were ideal for an endoscopic transgastric pseudocystogastrostomy.
Chronic pancreatitis. CT scans of the abdomen following an endoscopic transgastric pseudocystogastrostomy. Note that 2 stents are placed through the stomach and into the pseudocyst. Before undertaking this type of endoscopic intervention, the endoscopist must be confident that a cystadenoma has not been mistaken for a pseudocyst.
Chronic pancreatitis. This patient had a persistent postoperative leak from the site of a distal pancreatectomy. In the mid-1990s, the author sought to facilitate enteric drainage using transpapillary stents placed into the pancreatic duct. While this changed the fluid dynamics in favor of healing the disrupted duct, some patients developed complications from this technique.
Chronic pancreatitis. The persistent postoperative leak from the site of a distal pancreatectomy has healed at 1-month follow-up (see the image above). However, after 4 weeks of transpapillary stenting, the pancreatogram now shows a stent-induced stenosis near the surgical genu (arrow). Based on this experience, the author stopped using pancreatic stents in this setting.
Chronic pancreatitis. This patient developed abdominal pain several weeks after being accidentally hit with a baseball bat. A CT scan showed a large splenic hematoma, and the patient underwent a splenectomy. His postoperative course was notable for recurrent pain, abdominal distension, and elevation of serum amylase levels over the course of 2-3 months. This repeat CT scan shows postsurgical changes in the left upper quadrant and a large fluid collection.
Chronic pancreatitis. The pancreatogram shows a small leak from the tail of the gland.
Chronic pancreatitis. A nasopancreatic tube courses through the esophagus, stomach, and duodenum and into the pancreatic duct. Externally, the end of the tube is attached to a suction bulb to decompress the ductal system and monitor its function on a daily basis. In contrast to patients treated with transpapillary stents, none of these patients ever has failed to return for a follow-up appointment. In addition, while stent obstruction and subsequent infection can occur with transpapillary stents, the author has not observed this complication while using nasopancreatic tubes.
Chronic pancreatitis. Nine days after placement of a nasopancreatic tube, a pancreatogram obtained via the tube showed that the disruption had healed (see the above image). The tube then was removed.
Chronic pancreatitis. This follow-up CT scan (see the above 2 images) shows a percutaneous tube in the left upper quadrant that was used to drain a fluid collection. It was removed after 4 weeks. The patient returned to work, regained his weight, and had no recurrence of abdominal pain or signs of a recurrent pancreatic leak.
Chronic pancreatitis. Pancreatogram in a patient with a pancreatic pseudocyst. Note how the pancreatic ducts are extrinsically distorted by a mass lesion.
This pancreatogram shows a pseudocyst communicating with the main pancreatic duct in a patient with chronic pancreatitis and recurrent abdominal pain. He was treated endoscopically with a transpapillary stent placed into the pancreatic duct.
Four weeks after placement of a transpapillary stent, a patient with a pseudocyst communicating with the main pancreatic duct (chronic pancreatitis with recurrent abdominal pain) had not had a recurrence of pain. The CT scan showed resolution of the cyst, and the follow-up pancreatogram showed marked improvement. Transpapillary stenting of the pancreatic duct should be reserved for patients with established chronic pancreatitis.

of 15

Author

Jason L Huffman, MD Gastrointestinal Associates PC

Jason L Huffman, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kamil Obideen, MD Assistant Professor of Medicine, Division of Digestive Diseases, Emory University School of Medicine; Consulting Staff, Division of Gastrointestinal Endoscopy, Atlanta Veterans Affairs Medical Center

Kamil Obideen, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Mohammad Wehbi, MD Associate Professor of Medicine, Associate Program Director, Department of Gastroenterology, Emory University School of Medicine; Section Chief of Gastroenterology, Atlanta Veterans Affairs Medical Center

Mohammad Wehbi, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Paul Yakshe, MD Assistant Professor of Medicine, University of Minnesota, Medical Director of Pancreas and Biliary Clinic, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Fairview University Medical Center

Paul Yakshe, MD is a member of the following medical societies: American College of Gastroenterology, American Pancreatic Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chronic Pancreatitis Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?