Chronic and acute pancreatitis may be common GI problems, but that hasn’t made them less challenging to treat. The underlying causes are not well understood, and treatment is often limited to supportive therapies, according to Grace H. Elta, MD, AGAF, FASGE, professor of medicine and clinical director of the Medical Procedures Unit at the University of Michigan Health System, Ann Arbor.
Dr. Elta, who is also DDW Council Chair, will co-moderate Monday’s ASGE Clinical Symposium Pancreatic Duct Endotherapy: Caution or Full Steam Ahead with Brian C. Brauer, MD, FASGE, assistant professor of medicine in the division of gastroenterology and hepatology at the University of Colorado School of Medicine, Aurora. The session’s four expert presenters will review the current science and best practices for endotherapy in pancreatitis treatment.
“Pancreatitis is a frustrating disease, as we don’t really have any specific treatment — it’s more about trying to prevent it from recurring and treating the complications,” Dr. Elta said. “Some of that treatment involves endoscopic therapy, generally endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound-guided techniques performed by therapeutic endoscopists.”
In the symposium’s opening presentation, Vikesh K. Singh, MD, Msc, associate professor of medicine and director of the Pancreatitis Center at Johns Hopkins University School of Medicine, Baltimore, MD, will discuss the endoscopic treatment of leaks in the pancreatic duct, which can occur in severe cases.
“We do have some techniques to treat leaks that usually involve stenting of the pancreatic duct,” Dr. Elta said. “Dr. Singh will cover the science and the literature behind that, including how well it works, when it doesn’t work and what type of stent to use.”
Douglas A Howell, MD, FASGE, FACG, assistant clinical professor of medicine at Tufts Medical Center, Boston, MA, and director of the Pancreaticobiliary Center at Maine Medical Center, Portland, will follow with an analysis of endotherapies for treating other complications, including the chronic pain often associated with pancreatitis.
“Patients can get pretty desperate if they’re dealing with daily chronic pain. We try to keep them off narcotics so they don’t become addicted, but a lot of times we don’t have much to offer,” Dr. Elta said.
Gregory A. Cote, MD, FASGE, associate professor at the Medical University of South Carolina, Charleston, will address the challenge of minor papilla interventions.
“It’s estimated that about 5 to 7 percent of the population has a congenital variant known as pancreatic divisum, in which they have two ducts draining their pancreas instead of one,” Dr. Elta said. “It means most of the pancreatic duct drains through what we call the minor papilla, a smaller papilla that is normally not present and is a little bit harder to access. This variant usually causes no problems, but we think it could contribute to episodes of recurrent pancreatitis in some patients. Dr. Cote will talk about techniques to access the minor papilla and when to try to access it.”
In the final presentation, Manuel Perez-Miranda, MD, director of the gastroenterology and hepatology department at Hospital Universitario Rio Hortega, Valladolid, Spain, will provide tips for EUS-guided pancreatic duct access.
“Most of the time when we’re doing pancreatic endotherapy, we access the pancreatic duct via the opening into the intestine where pancreatic juices normally drain. But occasionally, like in a really scarred pancreas or an altered anatomy, we can’t get in there using traditional techniques,” Dr. Elta said. “In those cases, we do have another way of getting into the pancreatic duct and treating it, and that’s by endoscopic ultrasound. While it’s a fairly advanced and a much higher-risk procedure, Dr. Perez-Miranda is an expert, and he will discuss the indications and outcomes of the procedure.”
Please refer to the DDW Mobile App or the Program section in Monday’s issue for the time and location of this and other DDW® events.