Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis.

BACKGROUND Pain and functional deterioration in chronic pancreatitis is multifactorial. Early surgery in non-alcoholic patients with mild to moderate chronic pancreatitis can relieve pain and prevent progression of pancreatic insufficiency for some time, but the good results are only short term. Endoscopic intervention can relieve pain and recover pancreatic function without surgery. METHODS AND RESULTS To achieve the burned out state of chronic pancreatitis, occlusion of the pancreatic duct was first attempted by our team with Ethibloc at ERCP. Temporary obstruction of the pancreatic duct did not result in a long-lasting symptom and relapse-free situation because of early recovery of pancreatic function. On the contrary, endoscopic simple and double papillotomy, pancreatic drainage with citrate lavage, biliary endoprosthesis with multiple stents and endoscopic decompression of pseudocysts with or without jejunal feeding resulted in pain-free patients for a considerable time and in several cases significant functional recovery occurred. In cases where pain remained, percutaneous celiac plexus block with long-lasting steroids can be applied and only if all of these treatments fail should surgery be recommended. CONCLUSION Endoscopic intervention can successfully substitute for surgery for chronic pancreatitis in individual cases.

[1]  S. Ashley,et al.  Pancreatic blood flow in cats with chronic pancreatitis. , 1992, Gastroenterology.

[2]  R. Hawes,et al.  Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. , 1991, Gastrointestinal endoscopy.

[3]  J. Sahel.  Endoscopic Drainage of Pancreatic Cysts , 1991, Endoscopy.

[4]  N. Ebbehøj,et al.  Pancreatic tissue fluid pressure during drainage operations for chronic pancreatitis. , 1990, Scandinavian journal of gastroenterology.

[5]  M. Büchler,et al.  Duodenum-preserving resection of the head of the pancreas--an alternative to Whipple's procedure in chronic pancreatitis. , 1990, Hepato-gastroenterology.

[6]  A. Lebovits,et al.  Pain management of pancreatic carcinoma: a review , 1989, Pain.

[7]  W. Nealon,et al.  Operative Drainage of the Pancreatic Duct Delays Functional Impairment in Patients with Chronic Pancreatitis: A Prospective Analysis , 1988, Annals of surgery.

[8]  P. Malfertheiner,et al.  Analysis of nerves in chronic pancreatitis. , 1988, Gastroenterology.

[9]  L. Traverso,et al.  Infected pancreatic fluid collections: percutaneous catheter drainage. , 1988, Radiology.

[10]  G. Tytgat,et al.  Endoscopic pancreatic drainage in chronic pancreatitis. , 1988, Gastrointestinal endoscopy.

[11]  C. Frey,et al.  Description and Rationale of a New Operation for Chronic Pancreatitis , 1987, Pancreas.

[12]  A. Waltschew,et al.  The papilla of Vater and chronic pancreatitis. , 1986, Hepato-gastroenterology.

[13]  H. Benzon.  Epidural steroid injections for low back pain and lumbosacral radiculopathy , 1986, Pain.

[14]  M. Devor,et al.  Corticosteroids suppress ectopic neural discharge originating in experimental neuromas , 1985, Pain.

[15]  Frey Cf,et al.  Surgery in chronic pancreatitis. , 1984 .

[16]  P. Cotton,et al.  Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis , 1983, The British journal of surgery.

[17]  S. Owitz,et al.  Celiac plexus block: an overview. , 1983, The Mount Sinai journal of medicine, New York.

[18]  C. Gebhardt,et al.  [A new concept in the surgery of chronic pancreatitis (author's transl)]. , 1979, Deutsche medizinische Wochenschrift.

[19]  J. Fahrenkrug,et al.  pH threshold for release of secretin in normal subjects and in patients with duodenal ulcer and patients with chronic pancreatitis. , 1978, Scandinavian journal of gastroenterology.

[20]  S. Lahiri,et al.  PARAPLEGIA FOLLOWING COELIAC PLEXUS BLOCK WITH PHENOL , 1974 .

[21]  H. Sarles,et al.  Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. , 1965, Gut.