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Endoscopic Management of Recurrent Acute Pancreatitis.

Pier Alberto Testoni¹, Sabrina Testoni²

¹Gastroenterology and Gastrointestinal Endoscopy, La Madonnina Clinic, Vita-Salute San Raffaele University, 20100 Milan, Italy.

Journal of Clinical Medicine

|April 12, 2025

Summary

Endoscopic therapy effectively manages recurrent acute pancreatitis (RAP) when obstructions are present, such as gallstones or sphincter of Oddi dysfunction. However, its utility is less clear for idiopathic RAP or when no obstruction is found.

Keywords:

ERCP-guided therapy recurrent acute pancreatitis recurrent idiopathic acute pancreatitis

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Area of Science:

Gastroenterology
Endoscopy
Pancreatology

Background:

Recurrent acute pancreatitis (RAP) involves repeated episodes of pancreatic inflammation.
Causes include gallstones, sphincter of Oddi dysfunction (SOD), ductal abnormalities, genetics, and alcohol.
Idiopathic RAP (IRAP) accounts for a significant portion, though advanced diagnostics may reduce this.

Purpose of the Study:

To review the role and outcomes of endoscopic therapy in managing RAP.
To assess the effectiveness of endoscopic interventions for various causes of RAP.

Main Methods:

Review of literature on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) for RAP.
Analysis of outcomes based on identified etiologies and endoscopic procedures performed.

Main Results:

Endoscopic therapy is effective for RAP caused by mechanical obstructions like gallstones or type 1 SOD.
Sphincterotomy shows success in pancreas divisum with dorsal duct dilation.
Efficacy is questionable for type 2 SOD without confirmed dysfunction and for IRAP due to limited data.

Conclusions:

Endoscopic therapy is a valuable tool for obstructive RAP, improving management and outcomes.
Careful patient selection is crucial, particularly for non-obstructive conditions and IRAP.
Further research is needed to clarify the role of endotherapy in IRAP and non-obstructive RAP.