Chronic pancreatitis
ICD-10 K86.0 · ICD-11 DC32

Abdominal Pain in Compensated Chronic Pancreatitis When Endoscopic Treatment Has Not Relieved Pain

Clinical scenario

This protocol covers patients with chronic pancreatitis in the compensated stage presenting with abdominal pain and back pain. In this stage, pancreatic endocrine and exocrine function remains largely intact, and abdominal pain is the defining symptom. Preventing relapses and achieving pain control are the central priorities.

Prior treatment — insufficient response

Endoscopic treatment — including extracorporeal shock wave lithotripsy (ESWL), endoscopic pancreatic duct incision, endoscopic stone removal, and endoscopic placement of a pancreatic duct stent — was applied for abdominal pain from pancreatic duct obstruction but did not achieve adequate relief of abdominal pain. This protocol describes the next step taken after that failure.

Next-step approach (partial overview)

When endoscopic treatment has been ineffective for pain relief, the structured protocol moves to a surgical approach. The full regimen specifies the procedures involved, their selection criteria, and the conditions under which each applies.

Procedure selection, sequencing, and eligibility criteria are available in the full protocol.

Treatment goal

Resolution of pain.

Instant Access to Structured Evidence-Based Regimens

References

  1. Abdominal pain is the main symptom during the latent to compensatory stage, when there is no obvious impairment of pancreatic endocrine and exocrine function.
  2. In the compensated stage, prevention of repeated relapses and pain takes priority.
  3. Surgical treatment is recommended for patients in whom endoscopic treatment has been ineffective for pain relief.
  4. Although endoscopic treatment is the first choice for pain control in patients with CP for whom conservative medical treatment is ineffective, surgical treatment is recommended for the cases in which endoscopic treatment is unsuccessful or ineffective (Fig. 4).
  5. Pancreatectomy, pancreaticojejunostomy, and abscess drainage were reported to achieve complete resolution of pain in approximately 62.5% of cases in which pain resolution had been inadequate after endoscopic pancreatic stenting.

DOI: 10.1007/s00535-022-01911-6

View source ↗