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<p>Pancreatic obstruction is a&#xa0;common complication of chronic pancreatitis. Local parenchymal damage due to ongoing inflammation promotes both benign strictures leading to obstruction and the formation of obstructing stones. The basis of therapy is analgesia according to the World Health Organization analgesic ladder, considering the addition of a&#xa0;co-analgesic, as well as the treatment of exo- and endocrine insufficiency, when present. Symptomatic pancreatic obstruction generally warrants therapeutic intervention. Endoscopic therapy often leads to short-term pain relief; however, it is inferior to surgical therapy in terms of long-term pain control. Therefore, any endoscopic treatment attempt should be limited in time, or surgery may be considered up-front. In case of bile duct stenosis in the context of chronic pancreatitis, rapid therapy should be initiated in the presence of cholangitis. If cholestasis persists, an initial endoscopic treatment attempt should be made, but surgery should be considered no later than 12&#xa0;months after therapy initiation. Concerning surgery, the resecting and draining techniques must be evaluated on an individual patient basis. For all patients, an interdisciplinary case discussion should take place within a&#xa0;dedicated pancreas board.</p>

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Obstruktive chronische Pankreatitis

  • 期刊论文

  • 发表日期：

    2025年6月19日

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  • Jakob Vielhauer,
  • Liva Rudroff,
  • Bernhard W. Renz

摘要

Pancreatic obstruction is a common complication of chronic pancreatitis. Local parenchymal damage due to ongoing inflammation promotes both benign strictures leading to obstruction and the formation of obstructing stones. The basis of therapy is analgesia according to the World Health Organization analgesic ladder, considering the addition of a co-analgesic, as well as the treatment of exo- and endocrine insufficiency, when present. Symptomatic pancreatic obstruction generally warrants therapeutic intervention. Endoscopic therapy often leads to short-term pain relief; however, it is inferior to surgical therapy in terms of long-term pain control. Therefore, any endoscopic treatment attempt should be limited in time, or surgery may be considered up-front. In case of bile duct stenosis in the context of chronic pancreatitis, rapid therapy should be initiated in the presence of cholangitis. If cholestasis persists, an initial endoscopic treatment attempt should be made, but surgery should be considered no later than 12 months after therapy initiation. Concerning surgery, the resecting and draining techniques must be evaluated on an individual patient basis. For all patients, an interdisciplinary case discussion should take place within a dedicated pancreas board.