CHRONIC-PANCREATITIS - DIAGNOSIS AND TREATMENT

Three-dimensional magnetic resonance cholangiopancreatography is curre ntly the most exciting new imaging technique for chronic pancreatitis. Endoscopy-assisted duodenal intubation during the secretin-cholecysto kinin test reduces intubation time in difficult cases. The NBT-para-am ino benzoic acid test has been refined to enhance its discriminant pow er. The cholesteryl[C-13]octanoate breath test and the faecal elastase test are newer highly sensitive and specific tubeless tests. Pain in chronic pancreatitis continues to be a vexing therapeutic issue. Enzym e treatment continues despite criticism. Neurotensin is the new suspec ted mediator of the feedback mechanism, which is downregulated by enzy me therapy. Steroid ganglion block is an exciting therapeutic tool for pain relief. Endoscopic pancreatic sphincterotomy, Dormia basketing a nd pancreatic stenting in conjunction with extracorporeal shock wave l ithotripsy should be performed early in chronic pancreatitis to preven t parenchymal atrophy with ensuing exocrine and endocrine pancreatic d ysfunction. The modified Puestow's procedure preserves endocrine and e xocrine pancreatic functions besides relieving pain. Closed loop insul in infusion allows superior management of pancreatic diabetes followin g near total pancreatectomy. The standardised incidence rate of pancre atic cancer is 16.5 in patients with alcoholic chronic pancreatitis an d 100 for tropical chronic pancreatitis. Aggressive treatment protocol s combining neo-adjuvant chemoradiation and intra-operative radiation with surgery are being used to improve the prognosis in this dismal co mplication of chronic pancreatitis.