Update of diagnosis and treatment strategies for chronic pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xiang ,  LIAO Quan

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

LIAO Quan, Email: lqpumc@126.com

Keywords：

chronic pancreatitis; diagnosis; treatment

DOI：

10.7507/1007-9424.201703033

Video：

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Objective To explore changes and challenges on management of chronic pancreatitis. Methods The updated clinical guidelines and the latest research findings were collected and reviewed. Results The proposition of a new mechanistic definition and identification of an early stage give us a novel insight into chronic pancreatitis. The intraductal pancreatic calcifications has been regarded as the most reliable ultrasonography and CT features of chronic pancreatitis. In addition, the endoscopic ultrasonography is also of great value. The present surgical strategies are established on the concepts of step-up approach and damage control. The surgery perform better than the endoscopic treatment in the long-term outcome, but the timing course of surgery need to be further investigated. Conclusions Early diagnosis and treatment plays a critical role in cases of chronic pancreatitis. More patients of chronic pancreatitis should be treated in a multidisciplinary team as future perspectives.

Citation： ZHANG Xiang, LIAO Quan. Update of diagnosis and treatment strategies for chronic pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(11): 1414-1418. doi: 10.7507/1007-9424.201703033 Copy

1.	中华医学会外科学分会胰腺外科学组. 慢性胰腺炎诊治指南(2014). 中华外科杂志, 2015, 53(4): 241-246.
2.	Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas, 2014, 43(8): 1143-1162.
3.	Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol, 2016, 51(2): 85-92.
4.	Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol, 2015, 53(12): 1447-1495.
5.	Whitcomb DC, Frulloni L, Garg P, et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology, 2016, 16(2): 218-224.
6.	Chari ST. Defining chronic pancreatitis. Pancreatology, 2016, 16(5): 694-695.
7.	中华胰腺病杂志编委会, 中华医学会消化内镜学分会. 慢性胰腺炎诊治指南(2012, 上海). 中华消化内镜杂志, 2012, 29(6): 301-303.
8.	庄岩, 杨尹默, 王维民, 等. 慢性胰腺炎的分期及临床应用. 中华肝胆外科杂志, 2008, 14(11): 763-765.
9.	Masamune A, Kikuta K, Nabeshima T, et al. Nationwide epidemiological survey of early chronic pancreatitis in Japan. J Gastroenterol, 2017, 52(8): 992-1000.
10.	Dimagno EP, Regan PT, Clain JE, et al. Human endoscopic ultrasonography. Gastroenterology, 1982, 83(4): 824-829.
11.	Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc, 2009, 69(7): 1251-1261.
12.	D’Souza SL, Anderson MA, Korsnes SJ, et al. EUS diagnostic criteria for chronic pancreatitis: a comparison of conventional versus Rosemont criteria. Dig Dis Sci, 2015, 60(12): 3782-3787.
13.	Trikudanathan G, Munigala S, Barlass U, et al. Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology - A retrospective study. Pancreatology, 2017, 17(1): 63-69.
14.	Trikudanathan G, Vega-Peralta J, Malli A, et al. Diagnostic performance of endoscopic ultrasound (EUS) for non-calcific chronic pancreatitis (NCCP) based on histopathology. Am J Gastroenterol, 2016, 111(4): 568-574.
15.	Majumder S, Chari ST. Chronic pancreatitis. Lancet, 2016, 387(10031): 1957-1966.
16.	Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology, 2016, 16(1): 83-94.
17.	Teo K, Johnson MH, Truter S, et al. Pain assessment in chronic pancreatitis: A comparative review of methods. Pancreatology, 2016, 16(6): 931-939.
18.	Uc A, Andersen DK, Bellin MD, et al. Chronic pancreatitis in the 21st century-Research challenges and opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas, 2016, 45(10): 1365-1375.
19.	DiMagno EP, DiMagno MJ. Chronic pancreatitis: Landmark papers, management decisions, and future. Pancreas, 2016, 45(5): 641-650.
20.	田伯乐, 李少军. 慢性胰腺炎的疼痛及其治疗策略. 中国普外基础与临床杂志, 2016, 23(6): 647-649.
21.	Park WG. Clinical chronic pancreatitis. Curr Opin Gastroenterol, 2016, 32(5): 415-421.
22.	Jawad ZAR, Kyriakides C, Pai M, et al. Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis. Asian J Surg, 2017, 40(3): 179-185.
23.	弓毅, 王槐志. 外科与内镜治疗慢性胰腺炎合并胰管结石的疗效对比. 中国普外基础与临床杂志, 2016, 23(6): 654-657.
24.	Korpela T, Udd M, Tenca A, et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol, 2016, 51(7): 866-871.
25.	Ahmed AU, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev, 2015, (3): CD007884.
26.	Yang CJ, Bliss LA, Freedman SD, et al. Surgery for chronic pancreatitis: the role of early surgery in pain management. Pancreas, 2015, 44(5): 819-823.
27.	Ueda J, Tanaka M, Ohtsuka T, et al. Surgery for chronic pancreatitis decreases the risk for pancreatic cancer: a multicenter retrospective analysis. Surgery, 2013, 153(3): 357-364.
28.	Pinho AV, Chantrill L, Rooman I. Chronic pancreatitis: a path to pancreatic cancer. Cancer Lett, 2014, 345(2): 203-209.
29.	Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer. Lancet, 2016, 388(10039): 73-85.
30.	Raimondi S, Lowenfels AB, Morselli-Labate AM, et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol, 2010, 24(3): 349-358.
31.	Ni Q, Yun L, Roy M, et al. Advances in surgical treatment of chronic pancreatitis. World J Surg Oncol, 2015, 13: 34.
32.	Issa Y, Bruno MJ, Bakker OJ, et al. Treatment options for chronic pancreatitis. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 556-564.
33.	Kleeff J, Stöß C, Mayerle J, et al. Evidence-based surgical treatments for chronic pancreatitis. Dtsch Arztebl Int, 2016, 113(29-30): 489-496.
34.	谭春路, 努尔买买提, 阿不来提•艾则孜, 等. 慢性胰腺炎手术治疗方式的选择. 中华外科杂志, 2016, 54(11): 848-853.
35.	Shalimar, Midha S, Hasan A, et al. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis. J Gastroenterol Hepatol, 2017, 32(1): 270-277.
36.	Ahmed Ali U, Issa Y, Bruno MJ, et al. Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE): design and rationale of a randomized trial. BMC Gastroenterol, 2013, 13: 49.
37.	Bliss LA, Yang CJ, Eskander MF, et al. Surgical management of chronic pancreatitis: current utilization in the United States. HPB (Oxford), 2015, 17(9): 804-810.
38.	Szücs Á, Marjai T, Szentesi A, et al. Chronic pancreatitis: Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group. PLoS One, 2017, 12(2): e0171420.

1. 中华医学会外科学分会胰腺外科学组. 慢性胰腺炎诊治指南(2014). 中华外科杂志, 2015, 53(4): 241-246.
2. Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas, 2014, 43(8): 1143-1162.
3. Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol, 2016, 51(2): 85-92.
4. Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol, 2015, 53(12): 1447-1495.
5. Whitcomb DC, Frulloni L, Garg P, et al. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology, 2016, 16(2): 218-224.
6. Chari ST. Defining chronic pancreatitis. Pancreatology, 2016, 16(5): 694-695.
7. 中华胰腺病杂志编委会, 中华医学会消化内镜学分会. 慢性胰腺炎诊治指南(2012, 上海). 中华消化内镜杂志, 2012, 29(6): 301-303.
8. 庄岩, 杨尹默, 王维民, 等. 慢性胰腺炎的分期及临床应用. 中华肝胆外科杂志, 2008, 14(11): 763-765.
9. Masamune A, Kikuta K, Nabeshima T, et al. Nationwide epidemiological survey of early chronic pancreatitis in Japan. J Gastroenterol, 2017, 52(8): 992-1000.
10. Dimagno EP, Regan PT, Clain JE, et al. Human endoscopic ultrasonography. Gastroenterology, 1982, 83(4): 824-829.
11. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc, 2009, 69(7): 1251-1261.
12. D’Souza SL, Anderson MA, Korsnes SJ, et al. EUS diagnostic criteria for chronic pancreatitis: a comparison of conventional versus Rosemont criteria. Dig Dis Sci, 2015, 60(12): 3782-3787.
13. Trikudanathan G, Munigala S, Barlass U, et al. Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology - A retrospective study. Pancreatology, 2017, 17(1): 63-69.
14. Trikudanathan G, Vega-Peralta J, Malli A, et al. Diagnostic performance of endoscopic ultrasound (EUS) for non-calcific chronic pancreatitis (NCCP) based on histopathology. Am J Gastroenterol, 2016, 111(4): 568-574.
15. Majumder S, Chari ST. Chronic pancreatitis. Lancet, 2016, 387(10031): 1957-1966.
16. Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology, 2016, 16(1): 83-94.
17. Teo K, Johnson MH, Truter S, et al. Pain assessment in chronic pancreatitis: A comparative review of methods. Pancreatology, 2016, 16(6): 931-939.
18. Uc A, Andersen DK, Bellin MD, et al. Chronic pancreatitis in the 21st century-Research challenges and opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas, 2016, 45(10): 1365-1375.
19. DiMagno EP, DiMagno MJ. Chronic pancreatitis: Landmark papers, management decisions, and future. Pancreas, 2016, 45(5): 641-650.
20. 田伯乐, 李少军. 慢性胰腺炎的疼痛及其治疗策略. 中国普外基础与临床杂志, 2016, 23(6): 647-649.
21. Park WG. Clinical chronic pancreatitis. Curr Opin Gastroenterol, 2016, 32(5): 415-421.
22. Jawad ZAR, Kyriakides C, Pai M, et al. Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis. Asian J Surg, 2017, 40(3): 179-185.
23. 弓毅, 王槐志. 外科与内镜治疗慢性胰腺炎合并胰管结石的疗效对比. 中国普外基础与临床杂志, 2016, 23(6): 654-657.
24. Korpela T, Udd M, Tenca A, et al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol, 2016, 51(7): 866-871.
25. Ahmed AU, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev, 2015, (3): CD007884.
26. Yang CJ, Bliss LA, Freedman SD, et al. Surgery for chronic pancreatitis: the role of early surgery in pain management. Pancreas, 2015, 44(5): 819-823.
27. Ueda J, Tanaka M, Ohtsuka T, et al. Surgery for chronic pancreatitis decreases the risk for pancreatic cancer: a multicenter retrospective analysis. Surgery, 2013, 153(3): 357-364.
28. Pinho AV, Chantrill L, Rooman I. Chronic pancreatitis: a path to pancreatic cancer. Cancer Lett, 2014, 345(2): 203-209.
29. Kamisawa T, Wood LD, Itoi T, et al. Pancreatic cancer. Lancet, 2016, 388(10039): 73-85.
30. Raimondi S, Lowenfels AB, Morselli-Labate AM, et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol, 2010, 24(3): 349-358.
31. Ni Q, Yun L, Roy M, et al. Advances in surgical treatment of chronic pancreatitis. World J Surg Oncol, 2015, 13: 34.
32. Issa Y, Bruno MJ, Bakker OJ, et al. Treatment options for chronic pancreatitis. Nat Rev Gastroenterol Hepatol, 2014, 11(9): 556-564.
33. Kleeff J, Stöß C, Mayerle J, et al. Evidence-based surgical treatments for chronic pancreatitis. Dtsch Arztebl Int, 2016, 113(29-30): 489-496.
34. 谭春路, 努尔买买提, 阿不来提•艾则孜, 等. 慢性胰腺炎手术治疗方式的选择. 中华外科杂志, 2016, 54(11): 848-853.
35. Shalimar, Midha S, Hasan A, et al. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis. J Gastroenterol Hepatol, 2017, 32(1): 270-277.
36. Ahmed Ali U, Issa Y, Bruno MJ, et al. Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE): design and rationale of a randomized trial. BMC Gastroenterol, 2013, 13: 49.
37. Bliss LA, Yang CJ, Eskander MF, et al. Surgical management of chronic pancreatitis: current utilization in the United States. HPB (Oxford), 2015, 17(9): 804-810.
38. Szücs Á, Marjai T, Szentesi A, et al. Chronic pancreatitis: Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group. PLoS One, 2017, 12(2): e0171420.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Update of diagnosis and treatment strategies for chronic pancreatitis

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