Chronic pancreatitis is a progressive inflammatory condition of the pancreas that leads to permanent damage, pain, and often malabsorption and diabetes. Unlike acute pancreatitis, which is typically a single episode, chronic pancreatitis persists and worsens over time.
Dr. Kalpit Devani, an interventional gastroenterologist in Greenville, South Carolina, specializes in advanced endoscopic approaches to pancreatic disease. This overview covers causes, symptoms, and the role of ERCP and diagnostic and therapeutic EUS in managing chronic pancreatitis when endoscopic options are appropriate.
What Is Chronic Pancreatitis?
Chronic pancreatitis results from repeated inflammation that scars and damages the pancreas. Common causes include long-term alcohol use, genetic mutations (hereditary pancreatitis), autoimmune disease, and idiopathic (unknown) causes. The damaged gland loses its ability to produce digestive enzymes and insulin, leading to malabsorption, weight loss, and diabetes.
Symptoms: Pain, Malabsorption, Diabetes
Pain is the most common symptom, often epigastric, radiating to the back, worsened by eating. Malabsorption causes steatorrhea (fatty stools), weight loss, and vitamin deficiencies. Diabetes develops when insulin-producing cells are destroyed. Patients may also experience nausea and early satiety.
Diagnosis: Imaging, EUS, and Pancreatic Function
Imaging (CT, MRI, EUS) identifies duct dilation, calcifications, and structural changes. EUS offers high-resolution visualization of the pancreas and duct and can detect early changes before CT. Pancreatic function testing may be used when imaging is equivocal.
Endoscopic Treatment Options: ERCP for Strictures and Stones
ERCP (endoscopic retrograde cholangiopancreatography) allows access to the pancreatic duct through the mouth. Strictures can be dilated and stented. Stones can be extracted or fragmented. Stent placement relieves duct obstruction and can reduce pain in selected patients. Dr. Devani performs complex ERCP for pancreatic duct disease when anatomy permits.
EUS-Guided Celiac Plexus Block for Pain Management
For refractory pain, EUS-guided celiac plexus block delivers medication to the nerve bundle that transmits pancreatic pain. This minimally invasive procedure can provide months of relief and is an alternative to opioids when appropriate. It is performed by experienced interventional endoscopists such as Dr. Devani.
EUS-Guided Pancreatic Duct Drainage in Select Cases
When ERCP cannot access the pancreatic duct (due to prior surgery or obstruction), EUS-guided pancreatic duct drainage may be an option. A stent is placed from the stomach or duodenum into the pancreatic duct under EUS guidance. This is a technically demanding procedure reserved for specialized centers.
When Surgery Is Needed vs. Endoscopic Management
Surgery is considered when endoscopic options are exhausted or when structural disease (e.g., large pseudocysts, duct disruption) requires resection or drainage. Many patients achieve meaningful pain relief and improved duct drainage through endoscopic therapy before surgery is necessary.
If you or a loved one have chronic pancreatitis and need evaluation for endoscopic treatment, or for referrals and consultations, Dr. Devani welcomes inquiries from patients and referring physicians in Greenville, South Carolina and beyond. Services include comprehensive EUS and complex ERCP for pancreatic disease.
Frequently Asked Questions
What causes chronic pancreatitis?
Alcohol, genetic factors, autoimmune disease, and idiopathic causes. Repeated inflammation leads to scarring and permanent damage.
Can endoscopy treat chronic pancreatitis?
Yes. ERCP can dilate strictures, remove stones, and place stents. EUS-guided celiac plexus block can reduce pain. EUS-guided duct drainage may be an option when ERCP fails.
When is surgery needed for chronic pancreatitis?
Surgery is considered when endoscopic therapy no longer helps or when anatomy requires resection. Many patients respond to endoscopic management first.
Does EUS help diagnose chronic pancreatitis?
Yes. EUS provides high-resolution imaging of the pancreas and duct and can detect early changes before they appear on CT or MRI.
Dr. Kalpit Devani, MD, FACP, FACG, FASGE is a board-certified interventional gastroenterologist based in Greenville, South Carolina, specializing in diagnostic and therapeutic EUS, complex ERCP, and endoscopic suturing.
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Read more →This article is for educational purposes only and does not constitute medical advice. Please consult your physician for individualized care.