Endoscopic management in the complications of chronic pancreatitis.

This review outlines the indications and results of endoscopic management i n the complications of chronic pancreatitis. Symptomatic obstructions of th e main pancreatic duct can be treated by endocanalar prosthesis in case of fibrous stenosis and by extracorporeal shock wave lithotripsy in case or in traductal obstructive stones. Symptomatic or large pseudocysts have to be t reated and may be treated by placement of transgastric or transduodenal end oprosthesis for pseudocysts protuding into the digestive tract and by using transpapillary endoprosthesis for communicating pseudocysts. Endoscopic tr eatment of ductal disruptions is difficult and generally requires combined techniques. Symptomatic biliary stenosis can be temporary treated using bil iary endoprothesis. Short and long term results and complications of these different procedures are analysed. In the absence of controlled studies, th e role of endoscopic treatment in comparison to surgical treatment is not w ell defined. Present indications for either approach can be discussed on an individual basis. (C) 2000 Editions scientifiques et medicales Elsevier SA S.