[Conservative and interventional therapy of chronic pancreatitis]

In chronic pancreatitis high-dose enzyme therapy is only indicated if an insufficiency of the exocrine gland exists. For pain conventional analgesics such as Paracetamol, Metamizol or Tramadol are indicated. In case of pancreolithiasis, ESWL is the method of choice. This treatment should be combined with papillotomy of the pancreatic sphincter to achieve a good access to the duct system. If strictures are seen during ERCP, balloon dilatation and consecutive implantation of a plastic prosthesis are necessary to permit regular flow of pancreatic juice. Stent-clogging is the main problem of drainage-procedures. Regular exchange of the stent is mandatory. Pseudocysts should be drained via the papilla if there is a connection between the cyst and the duct system. All others should be drained endoscopically, by puncturing the cyst through the gastric or duodenal wall, or percutaneously. Surgical procedures should be delayed whenever possible, since surgical treatment is invasive (e.g. Whipple's operation) and the long-term prognosis is poor.