Endoscopic and Minimally Invasive Therapy for Complications of Pancreatitis

Abstract Although acute pancreatitis (AP) and chronic pancreatitis (CP) have historically been approached as separate clinical entities, advances in the understanding of the pathogenesis of both diseases have led to the recognition that AP, recurrent AP, and CP represent a disease continuum. As a part of the spectrum of disease, these inflammatory conditions can result in local complications that necessitate invasive treatment. In AP, these complications can include inflammatory pancreatic fluid collections, biliary, gastric, or duodenal obstruction, splenic and portal vein thrombosis, gastrointestinal bleeding/pseudoaneurysms, and internal/external fistulization. Patients with CP remain at risk for pseudocysts and biliary obstruction, in addition to chronic pain with pancreaticolithiasis or pancreatic ductal strictures. In the past decade, less-invasive endoscopic, percutaneous, and laparoscopic therapies to address these complications have been developed in an effort to reduce the morbidity associated with traditional open surgical techniques. Rapid expansion of medical technology continues to evolve clinical management strategies, and revised definitions for inflammatory pancreatic fluid collections have provided more homogeneous data on outcomes. Given the heterogeneity of clinical manifestations, local technical expertise, and anatomic variation, the therapies chosen should be individualized, preferably within the context of a multidisciplinary team of surgeons, gastroenterologists, and radiologists, taking into account the natural history and pathophysiology of the disease process.