Endoscopic therapy in acute recurrent pancreatitis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), and less invasive endoscopy, especially endoscopic ultrasound (EUS), have largely taken over from ERCP for diagnosis. However, ERCP remains the “first line” therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis, including bile duct stones (choledocholithiasis), ampullary masses (benign and malignant), congenital variants of biliary and pancreatic anatomy (e.g. pancreas divisum, choledochoceles), sphincter of Oddi dysfunction (SOD), pancreatic stones and strictures, and parasitic disorders involving the biliary tree and/or pancreatic duct (e.g Ascariasis, Clonorchiasis).

Keywords: Acute pancreatitis; Endoscopic retrograde cholangiopancreatography; Endoscopic Ultrasound; Choledocholithiasis; Ampullary lesions; Cystic tumors of the pancreas; Sphincter of Oddi dysfunction; Pancreas divisum; Choledochal cyst; Pancreatic stones