Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7308
Revised: July 15, 2013
Accepted: July 17, 2013
Published online: November 14, 2013
Processing time: 160 Days and 13.5 Hours
Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis (CP). For CP-related, uncomplicated, pancreatic pseudocysts (PPC), endoscopy is the first-choice therapeutic option. Recent advances have focused on endosonography-guided PPC transmural drainage, which tends to replace the conventional, duodenoscope-based coma immediately approach. Ancillary material is being tested to facilitate the endosonography-guided procedure. In this review, the most adequate techniques depending on PPC characteristics are presented along with supporting evidence. For CP-related biliary obstructions, endoscopy and surgery are valid therapeutic options. Patient co-morbidities (e.g., portal cavernoma) and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted option. Malignancy should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary strictures. In endoscopy, the gold standard technique consists of placing simultaneous, multiple, side-by-side, plastic stents for a one-year period. Fully covered self-expandable metal stents are challenging this method and have provided 50% mid-term success.
Core tip: Endoscopy is the first-choice treatment of pancreatic pseudocysts. The transduodenal route may be preferable over the transgastric route. Two transmural double pigtail stents should be left for at least 2 mo. In the case of a disconnected pancreatic tail, secretin-enhanced magnetic resonance pancreatography should be obtained to decide about stent removal. Biliary strictures should be thoroughly investigated to rule out malignancy. To this aim, improved methods of biliary sampling have become available. Even with multiple biliary stents, potentially fatal cholangitis is frequent in the absence of regular stent revision. Fully covered self-expandable metal stents have provided 50% mid-term success.