This is the current release of the guideline.

Chronic pancreatitis

Assessment of Therapeutic Effectiveness
Diagnosis
Management
Treatment

Family Practice
Gastroenterology
Internal Medicine

Physicians

To review the role of endoscopy in the management of chronic pancreatitis (CP)

Patients with chronic pancreatitis

1. Endoscopic retrograde cholangiopancreatography (ERCP)
2. Endoscopic ultrasonography (EUS)
3. Endoscopic therapy of pancreatic ductal obstruction
4. Endoscopic placement of pancreatic duct stents
5. EUS-guided celiac blockade

• Sensitivity and specificity of diagnostic tests
• Symptom improvement
• Therapeutic efficacy

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

A MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

Not stated

Expert Consensus

Not applicable

Review

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Not applicable

The levels of evidence (I–V) and strength of recommendations (A–C) are defined at the end of the "Major Recommendations" field.

Summary

• Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are useful for the diagnosis of chronic pancreatitis (CP) and associated pancreatic ductal complications (B).
• ERCP for the diagnosis of CP should be reserved for patients in who the diagnosis has not been established by noninvasive or less-invasive studies (C).
• Endoscopic therapy of pancreatic ductal obstruction can provide short-term relief of abdominal pain and long-term relief in some patients (B).
• ERCP is effective for the short-term treatment of common bile duct obstruction resulting from CP (B) and long-term treatment in poor operative candidates (C).
• Endoscopically placed pancreatic duct stents are effective for the nonsurgical management of pancreatic strictures, duct leaks, and disruptions (B).
• EUS-guided celiac blockade can effectively provide short-term pain relief in patients with CP (B).

Definitions:

1. Prospective controlled trials
2. Observational studies
3. Expert opinion

None provided

The type of supporting evidence is identified and classified for the recommendations using the following scheme:

1. Prospective controlled trials
2. Observational studies
3. Expert opinion

When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus.

Appropriate and effective use of endoscopy for diagnosis and treatment in patients with chronic pancreatitis

Complications related directly to endoscopic therapy of pancreatic duct (PD) strictures include pain, pancreatitis, stent occlusion, proximal or distal stent migration, duodenal erosions, pancreatic infection, ductal perforation, stone formation, and bleeding (if sphincterotomy is performed).

Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

An implementation strategy was not provided.

Living with Illness

Effectiveness

Not applicable: The guideline was not adapted from another source.

2006 Jun

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Standards of Practice Committee

Committee Members: Douglas G. Adler, MD; David Lichtenstein, MD; Todd H. Baron, MD (Chair); Raquel Davila, MD; James V. Egan, MD; Seng-Ian Gan, MD; Waqar A. Qureshi, MD; Elizabeth Rajan, MD; Bo Shen, MD; Marc J. Zuckerman, MD; Kenneth K. Lee, MD (NAPSGHAN Representative); Trina VanGuilder, RN (SGNA Representative); Robert D. Fanelli, MD (SAGES Representative)

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on October 9, 2006. The information was verified by the guideline developer on October 31, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.