Dealing With Complications of Chronic Pancreatitis 21 Aug 2021 17:10 17:30

Dealing With Complications of Chronic Pancreatitis 21 Aug 2021 17:10 17:30

- Supported by Abbott (20 mins)
Manu Tandan Speaker
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Chronic pancreatitis is a disease of multiple etiology with diverse manifestations. The complications and sequel of CP include Pancreatic strictures,CBD strictures, Pancreatic calculi, Pancreatic ductal leeks and pancreatic fluid collections. ERCP is the method of choice in managing most of these sequele. EUS is an emerging technology especially in the management of pancreatic fluid collections. Pancreatic strictures especially in the head and proximal body as well as partial ductal leaks are best managed by single plastic stents. If the stricture is not responding over 6 months to one year multiple plastic stents are placed. Fully covered SEMS in the use of Benign pancreatic strictures are a study in progress and no final word on this has been reached. CBD strictures are ideally managed with multiple plastic stents. The response to a single plastic stent for CBD stricture is poor especially if there is calcification in the head region. Fully FC SEMS have an important role in management of CBD stricture secondary to CP. Pancreatic calculi are a sequele of CP and are seen in 50% of patients of CP. Large calculi ( > 5mm ) are ideally subjected to Extra Corporeal Shockwave Lithotripsy (ESWL). This fragments the calculi which can be subsequently extracted at ERCP. Good short term and long term clinical success has been achieved with ESWL. Spyscope with use of intra ductal laser lithotripsy in an emerging technique for resistant stones. This however needs to be validated in large studies. EUS is the preferred modality of treatment for pancreatic fluid collections with many advantages. EUS is also used for cannulating the main pancreatic duct in case ERCP fails to achieve this. EUS guided coeliac block helps to relieve intractible pain in patients of CP. Endoscopy should be offered as the first line of treatment in properly selected patients with the above sequele of CP.

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