Chronic Pancreatitis (CP) is a long-term, progressive disease impacting the pancreas and the patient’s quality of life. Over time, CP can lead to ongoing pain, digestive problems, and various complications. If you have been diagnosed with CP, understanding treatment options—particularly those aimed at managing pain and complications—can be life changing. The American Society for Gastrointestinal Endoscopy (ASGE) provides guidelines on when and how endoscopic therapies should be used, giving patients and doctors a clear path toward effective management.
 
 

What is Chronic Pancreatitis?

Chronic Pancreatitis involves prolonged inflammation of the pancreas, changing its normal structure and function. Here is a look at common symptoms and complications:

• Persistent abdominal pain
• Nausea and vomiting
• Weight loss
• Diarrhea or oily stools (steatorrhea)
• Complications like pseudocysts, walled-off necrosis (pockets of dead tissue and fluid), and strictures (narrowing of ducts)

 
Since CP is progressive, early diagnosis and management are essential to prevent severe complications. Treatment options generally fall into surgical and endoscopic approaches. ASGE guidelines clarify when endoscopy might be the most suitable choice.
 
 

How Can Endoscopy Help in Chronic Pancreatitis?

Endoscopy is a minimally invasive procedure that uses a flexible tube with a camera to view the digestive tract and pancreas, allowing for both diagnosis and treatment. Here is a breakdown of key ASGE recommendations for endoscopic therapy in CP:
 

1. Endoscopic Therapy vs. Surgery for Pain Relief

CP can cause severe pain, often linked to a blocked pancreatic duct. ASGE suggests:

• Surgical Evaluation: Surgery should be considered first if viable.
• Endoscopic Approach: If surgery is not suitable or is not preferred, endoscopic therapy can be used to relieve pain by clearing ductal obstructions.

For You: If surgery is not an option or preferred, endoscopic therapy might offer pain relief by addressing ductal obstructions.
 

2. Celiac Plexus Block for Pain Management

A celiac plexus block (CPB) targets specific nerves to ease pain, with two primary approaches:

• EUS-Guided Approach: ASGE recommends endoscopic ultrasound (EUS) over percutaneous (through the skin) methods for more precise, effective pain control.

For You: If pain remains despite standard methods, an EUS-guided celiac plexus block might provide significant relief.
 

3. Managing Pancreatic Duct Stones

Pancreatic duct stones can block enzyme flow and worsen symptoms. ASGE guidelines advise different treatments based on stone characteristics:

• Large, Radiopaque Stones: For stones over 5 mm, endoscopic retrograde cholangiopancreatography (ERCP) with or without pancreatoscopy (a camera to enhance ERCP) or extracorporeal shock wave lithotripsy (ESWL) may be used.
• Smaller or Radiolucent Stones: Treated via ERCP with or without pancreatoscopy.

For You: If you have painful duct stones, your doctor will recommend a treatment based on stone type and size, often using endoscopic therapies like ERCP or ESWL to break up and remove stones.
 

4. Treating Pancreatic Duct Strictures

Narrowed pancreatic ducts (strictures) can block enzymes, increasing pain and inflammation. ASGE suggests:

• Using a Plastic Stent: Single plastic stents are generally recommended for initial treatment.
• Avoiding Metal Stents: Fully covered self-expanding metal stents (FCSEMSs) are used only in refractory cases.

For You: If you have a duct stricture, endoscopic stenting may help keep the duct open, chosen based on severity.
 

5. Managing Benign Biliary Strictures (BBSs)

Chronic Pancreatitis can lead to strictures in the bile duct, causing jaundice or liver issues. ASGE advises:

• Using Fully Covered Metal Stents: These are recommended over multiple plastic stents for treating biliary strictures.

For You: If CP has caused biliary strictures, an endoscopic stent using metal stents may provide better, longer-lasting results.
 

6. Treating Symptomatic Pseudocysts or Walled-Off Necrosis

Fluid-filled sacs or dead tissue (pseudocysts or walled-off necrosis) can develop due to pancreatitis. They may cause discomfort, nausea, obstruction, infection, or even organ failure. ASGE advises:

• Endoscopic Drainage: Endoscopic drainage is preferred over surgery for symptomatic pseudocysts and walled-off necrosis.

For You: If these complications are causing issues, endoscopic drainage offers a minimally invasive option that avoids surgery.
 
 

Comprehensive Care for Chronic Pancreatitis: A Team-Based Approach

Managing chronic pancreatitis effectively requires a team of specialized experts working together to address every aspect of the condition. The American Society for Gastrointestinal Endoscopy (ASGE) strongly endorses a multidisciplinary approach that brings together gastroenterologists, advanced/interventional endoscopists, surgeons, pain management specialists, and dietitians. This collaborative care model ensures that patients receive individualized treatment plans that not only target their symptoms but also focus on long-term health outcomes and quality of life.
 
At Bumrungrad International Hospital, we are dedicated to delivering top-tier care for patients with chronic pancreatitis. Our team of skilled gastroenterologists and advanced endoscopists stay aligned with the latest ASGE guidelines, ensuring our patients receive the most effective and evidence-based treatments. Whether you are facing pain, complications, or simply seeking guidance on managing chronic pancreatitis, we are here to support you every step of the way.
 
If you have been diagnosed with chronic pancreatitis or are experiencing symptoms, reach out to us today to schedule a consultation. Our team is committed to working with you to develop a personalized treatment plan that prioritizes your health and well-being.


 

Why Choose Bumrungrad International Hospital for Chronic Pancreatitis Care?

• Expert Team: Board-certified gastroenterologists with training in CP endoscopic therapies.
• Advanced Technology: We utilize state-of-the-art endoscopic techniques, including ERCP, EUS, and lithotripsy.
• Multidisciplinary Care: Comprehensive treatment through a collaborative approach.
• Patient-Centered Approach: Our focus is on your comfort, well-being, and long-term quality of life.

 
If you or a loved one has chronic pancreatitis, reach out to Bumrungrad International Hospital’s Digestive Disease Center to discuss endoscopic management and other tailored treatments for effective chronic pancreatitis care.
 

Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital