Therapeutic pancreatic endoscopy

Over the past decade, endoscopic retrograde cholangiopancreatography (ERCP) has developed from being a diagnostic tool to become one that is primarily used to provide therapy. This development occurred first for biliary disorders and more recently for primary diseases of the pancreas. Not only can new-generation computed tomography (CT), magnetic resonance imaging, and magnetic resonance cholangiopancreatography procedures suggest a diagnosis in the majority of individuals with pancreatic diseases today; in addition, ERCP-related complications can be minimized or avoided altogether in conjunction with positron-emission tomography or directed cytology or biopsy, either using ultrasound or CT guidance, or with tissue obtained during endoscopic ultrasonography. It is against this background that papers on therapeutic pancreatic endoscopy published during approximately the last year are reviewed here. Despite these developments, however, the following three issues concerning current advances in pancreatic endotherapy should be emphasized: firstly, most of the techniques reviewed here affect only a small number of patients; secondly, most of the techniques have been reported only by expert centers; and thirdly, most of the studies concerned have lacked control groups, and there is still a paucity of studies investigating endoscopic techniques on a randomized basis in comparison with surgery or medical therapy for the treatment of most benign and malignant pancreatic disorders.