Guideline:
The role of endoscopy in patients with chronic pancreatitis
Bibliographic Source(s)
- Adler DG Lichtenstein D Baron TH Davila R Egan JV Gan SL Qureshi WA Rajan E Shen B Zuckerman MJ Lee KK VanGuilder T Fanelli RD. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 2006 Jun;63(7):933-7. [55 references] PubMed
Guideline Status
This is the current release of the guideline.
Guideline Category
Assessment of Therapeutic Effectiveness
Diagnosis
Management
Treatment
Intended Users
Physicians
Guideline Objective(s)
To review the role of endoscopy in the management of chronic pancreatitis (CP)
Target Population
Patients with chronic pancreatitis
Interventions and Practices Considered
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopic ultrasonography (EUS)
- Endoscopic therapy of pancreatic ductal obstruction
- Endoscopic placement of pancreatic duct stents
- EUS-guided celiac blockade
Major Outcomes Considered
- Sensitivity and specificity of diagnostic tests
- Symptom improvement
- Therapeutic efficacy
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
A MEDLINE literature search was performed and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well designed prospective trials emphasis is given to results from large series and reports from recognized experts.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Not stated
Description of Method of Guideline Validation
Not applicable
Major Recommendations
The levels of evidence (I–V) and strength of recommendations (A–C) are defined at the end of the "Major Recommendations" field.
Summary
- Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are useful for the diagnosis of chronic pancreatitis (CP) and associated pancreatic ductal complications (B).
- ERCP for the diagnosis of CP should be reserved for patients in who the diagnosis has not been established by noninvasive or less-invasive studies (C).
- Endoscopic therapy of pancreatic ductal obstruction can provide short-term relief of abdominal pain and long-term relief in some patients (B).
- ERCP is effective for the short-term treatment of common bile duct obstruction resulting from CP (B) and long-term treatment in poor operative candidates (C).
- Endoscopically placed pancreatic duct stents are effective for the nonsurgical management of pancreatic strictures duct leaks and disruptions (B).
- EUS-guided celiac blockade can effectively provide short-term pain relief in patients with CP (B).
Definitions:
- Prospective controlled trials
- Observational studies
- Expert opinion
Clinical Algorithm(s)
None provided
Type of Evidence supporting the Recommendations
The type of supporting evidence is identified and classified for the recommendations using the following scheme:
- Prospective controlled trials
- Observational studies
- Expert opinion
When little or no data exist from well-designed prospective trials emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus.
Potential Benefits
Appropriate and effective use of endoscopy for diagnosis and treatment in patients with chronic pancreatitis
Potential Harms
Complications related directly to endoscopic therapy of pancreatic duct (PD) strictures include pain pancreatitis stent occlusion proximal or distal stent migration duodenal erosions pancreatic infection ductal perforation stone formation and bleeding (if sphincterotomy is performed).
Qualifying Statements
Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Living with Illness
IOM Domain
Effectiveness
Bibliographic Source(s)
- Adler DG Lichtenstein D Baron TH Davila R Egan JV Gan SL Qureshi WA Rajan E Shen B Zuckerman MJ Lee KK VanGuilder T Fanelli RD. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 2006 Jun;63(7):933-7. [55 references] PubMed
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Society for Gastrointestinal Endoscopy
Guideline Committee
Standards of Practice Committee
Composition of Group that Authored the Guideline
Committee Members: Douglas G. Adler MD; David Lichtenstein MD; Todd H. Baron MD (Chair); Raquel Davila MD; James V. Egan MD; Seng-Ian Gan MD; Waqar A. Qureshi MD; Elizabeth Rajan MD; Bo Shen MD; Marc J. Zuckerman MD; Kenneth K. Lee MD (NAPSGHAN Representative); Trina VanGuilder RN (SGNA Representative); Robert D. Fanelli MD (SAGES Representative)
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Society for Gastrointestinal Endoscopy Web site.
Print copies: Available from the American Society for Gastrointestinal Endoscopy 1520 Kensington Road Suite 202 Oak Brook IL 60523
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI on October 9 2006. The information was verified by the guideline developer on October 31 2006.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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