Sunil G Sheth et al., 2024: American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations

ASGE Standards of Practice Committee; Sunil G Sheth 1, Jorge D Machicado 2, Jean M Chalhoub 3, Christopher Forsmark 4, Nicholas Zyromski 5, Nirav C Thosani 6, Nikhil R Thiruvengadam 7, Wenly Ruan 8, Swati Pawa 9, Saowanee Ngamruengphong 10, Neil B Marya 11, Divyanshoo R Kohli 12, Larissa L Fujii-Lau 13, Nauzer Forbes 14, Sherif E Elhanafi 15, Madhav Desai 6, Natalie Cosgrove 16, Nayantara Coelho-Prabhu 17, Stuart K Amateau 18, Omeed Alipour 19, Wasif Abidi 20, Bashar J Qumseya 4; ASGE Standards of Practice Committee Chair
1Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
2Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
3Division of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
4Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.
5Department of Surgery, Indiana University, Indianapolis, Indiana, USA.
6Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA.
7Department of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA.
8Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
9Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
10Division of Gastroenterology and Hepatology, The Johns Hopkins University, Baltimore, Maryland, USA.
11Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA.
12Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Elon Floyd School of Medicine, Washington State University, Spokane, Washington, USA.
13Department of Gastroenterology, University of Hawaii, Honolulu, Hawaii, USA.
14Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
15Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
16Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
17Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
18Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
19Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA.
20Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.

Abstract

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the management of chronic pancreatitis (CP). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses effectiveness of endoscopic therapies for the management of pain in CP, including celiac plexus block, endoscopic management of pancreatic duct (PD) stones and strictures, and adverse events such as benign biliary strictures (BBSs) and pseudocysts. In patients with painful CP and an obstructed PD, the ASGE suggests surgical evaluation in patients without contraindication to surgery before initiation of endoscopic management. In patients who have contraindications to surgery or who prefer a less-invasive approach, the ASGE suggests an endoscopic approach as the initial treatment over surgery, if complete ductal clearance is likely. When a decision is made to proceed with a celiac plexus block, the ASGE suggests an EUS-guided approach over a percutaneous approach. The ASGE suggests indications for when to consider ERCP alone or with pancreatoscopy and extracorporeal shock wave lithotripsy alone or followed by ERCP for treating obstructing PD stones based on size, location, and radiopacity. For the initial management of PD strictures, the ASGE suggests using a single plastic stent of the largest caliber that is feasible. For symptomatic BBSs caused by CP, the ASGE suggests the use of covered metal stents over multiple plastic stents. For symptomatic pseudocysts, the ASGE suggests endoscopic therapy over surgery. This document clearly outlines the process, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.

Gastrointest Endosc. 2024 Aug 8:S0016-5107(24)03249-8. doi: 10.1016/j.gie.2024.05.016. Online ahead of print. PMID: 39115496