[Medical and endoscopic treatment of chronic pancreatitis]

Analgesics and pancreatic extracts are required for the management of pancreatic pain. The use of pancreatic enzymes supplements is necessary for the management of pancreatic insufficiency. Patients with diabetes should be treated with insulin since endogenous insulin secretion is decreased. Drainage procedures of the pancreatic ducts, drainage of pancreatic cysts and biliary prosthesis are different ways of endoscopic management for chronic pancreatitis and its related complications. Endoscopic drainage procedures of the pancreatic duct include pancreatic sphincterotomy, extraction of pancreatic stones by means of balloons or baskets or extra corporeal shock wave lithotripsy, pancreatic duct endoprosthesis. Clinical and anatomical results are good or fair in about two thirds of the cases but there are not yet controlled studies. Endoscopic management of pancreatic cysts use transmural drainage of cysts in contact with the stomach or duodenal wall or transpapillary drainage in cysts communicating with the pancreatic ductal system. The results and complications of the endoscopic treatment of pancreatic cysts are comparable to those of surgical series. Biliary stenting is an alternative to surgical diversion. Endoscopic management of chronic pancreatitis requires the development of new techniques which should be evaluated in further controlled studies.