Traitement endoscopique de la pancréatite chronique

Abstract

The treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as primary therapeutic option. Initially performed for the drainage of pancreatic cysts and pseudocysts, endoscopy was extended to stenosis of biliary and pancreatic ducts. Pancreatic sphincterotomy which allows access to the pancreatic ducts was first developed, rapidly followed by endoscopic biliary stenting, dilatation of stenosis, and stone extraction. Nevertheless, new improvements were necessary: failures in pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic strictures was improved by forage with new devices; endosonography allowed guidance for coeliac block, cyst-gastrostomy, cyst-duodenostomy and pancreatico-gastrostomy. Although endoscopic management is increasingly accepted, its indications are still debated.