Title

Role of Endoscopy in the Management of Chronic Pancreatitis

Authoring Organization

Publication Month/Year

August 8, 2024

Last Updated Month/Year

August 16, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the management of chronic pancreatitis (CP). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses effectiveness of endoscopic therapies for the management of pain in CP, including celiac plexus block, endoscopic management of pancreatic duct (PD) stones and strictures, and adverse events such as benign biliary strictures (BBSs) and pseudocysts. In patients with painful CP and an obstructed PD, the ASGE suggests surgical evaluation in patients without contraindication to surgery before initiation of endoscopic management. In patients who have contraindications to surgery or who prefer a less-invasive approach, the ASGE suggests an endoscopic approach as the initial treatment over surgery, if complete ductal clearance is likely. When a decision is made to proceed with a celiac plexus block, the ASGE suggests an EUS-guided approach over a percutaneous approach. The ASGE suggests indications for when to consider ERCP alone or with pancreatoscopy and extracorporeal shock wave lithotripsy alone or followed by ERCP for treating obstructing PD stones based on size, location, and radiopacity. For the initial management of PD strictures, the ASGE suggests using a single plastic stent of the largest caliber that is feasible. For symptomatic BBSs caused by CP, the ASGE suggests the use of covered metal stents over multiple plastic stents. For symptomatic pseudocysts, the ASGE suggests endoscopic therapy over surgery. This document clearly outlines the process, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.

Inclusion Criteria

Male, Female, Adult, Infant

Health Care Settings

Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D050500 - Pancreatitis, Chronic

Keywords

endoscopy, pancreatitis, chronic pancreatitis

Source Citation

ASGE Standards of Practice Committee; Sheth SG, Machicado JD, Chalhoub JM, Forsmark C, Zyromski N, Thosani NC, Thiruvengadam NR, Ruan W, Pawa S, Ngamruengphong S, Marya NB, Kohli DR, Fujii-Lau LL, Forbes N, Elhanafi SE, Desai M, Cosgrove N, Coelho-Prabhu N, Amateau SK, Alipour O, Abidi W, Qumseya BJ; ASGE Standards of Practice Committee Chair. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations. Gastrointest Endosc. 2024 Aug 8:S0016-5107(24)03249-8. doi: 10.1016/j.gie.2024.05.016. Epub ahead of print. PMID: 39115496.