Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis

Background: Pain and functional deterioration in chronic pancreatitis is mu ltifactorial. Early surgery in non-alcoholic patients with mild to moderate chronic pancreatitis can relieve pain and prevent progression of pancreati c insufficiency for some time, but the good results are only short term. En doscopic intervention can relieve pain and recover pancreatic function with out surgery. Methods and results: To achieve the burned out state of chroni c pancreatitis, occlusion of the pancreatic duct was first attempted by our team with Ethibloc at ERCP. Temporary obstruction of the pancreatic duct d id not result in a long-lasting symptom and relapse-free situation because of early recovery of pancreatic function. On the contrary, endoscopic simpl e and double papillotomy, pancreatic drainage with citrate lavage, biliary endoprosthesis with multiple stents and endoscopic decompression of pseudoc ysts with or without jejunal feeding resulted in pain-free patients for a c onsiderable time and in several cases significant functional recovery occur red. In cases where pain remained, percutaneous celiac plexus block with lo ng-lasting steroids can be applied and only if all of these treatments fail should surgery be recommended. Conclusion: Endoscopic intervention can suc cessfully substitute for surgery for chronic pancreatitis in individual cas es.