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Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment

Myriam Delhaye, Werner Van Steenbergen, Ercan Cesmeli, Paul Pelckmans, Virginie Putzeys, Geert Roeyen, Frederik Berrevoet UGent, Isabelle Scheers, Floriane Ausloos, Pierrette Gast, et al. (2014) ACTA GASTRO-ENTEROLOGICA BELGICA. 77(1). p.47-65
abstract
Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue. Clinicians should attempt to classify patients into one of the six etiologic groups according to the TIGARO classification system. MRI/MRCP, if possible with secretin enhancement, is considered the imaging modality of choice for the diagnosis of early-stage disease. In CP, pain is the most disabling symptom, with a significant impact on quality of life. Pain should be assessed using the Izbicki score and preferably treated using the "pain ladder" approach. In painful CP, endoscopic therapy (ET) can be considered as early as possible. This procedure can be combined with extracorporeal shock-wave lithotripsy (ESWL) in the presence of large (> 4 mm), obstructive stone(s) in the pancreatic head, and with ductal stenting in the presence of a single main pancreatic duct (MPD) stricture in the pancreatic head with a markedly dilated MPD. Pancreatic stenting should be pursued for at least 12 months in patients with persistent pain relief. On-demand stent exchange should be the preferred strategy. The simultaneous placement of multiple, side-by-side, pancreatic stents can be recommended in patients with MPD strictures persisting after 12 months of single plastic stenting. We recommend surgery in the following cases : a) technical failure of ET; b) early (6 to 8 weeks) clinical failure; c) definitive biliary drainage at a later time point; d) pancreatic ductal drainage when repetitive ET is considered unsuitable for young patients; e) resection of an inflammatory pancreatic head when pancreatic cancer cannot be ruled out; f) duodenal obstruction. Duodenopan-createctomy or oncological distal pancreatectomy should be considered for patients with suspected malignancy. Pediatricians should be aware of and systematically search for CP in the differential diagnosis of chronic abdominal pain. As malnutrition is highly prevalent in CP patients, patients at nutritional risk should be identified in order to allow for dietary counseling and nutritional intervention using oral supplements. Patients should follow a healthy balanced diet taken in small meals and snacks, with normal fat content. Enzyme replacement therapy is beneficial to symptomatic patients, but also in cases of subclinical insufficiency. Regular follow-up should be considered in CP patients, primarily to detect subclinical maldigestion and the development of pancreatogenic diabetes. Screening for pancreatic cancer is not recommended in CP patients, except in those with the hereditary form.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
DUODENUM-PRESERVING RESECTION, QUALITY-OF-LIFE, RANDOMIZED CONTROLLED-TRIAL, SHOCK-WAVE LITHOTRIPSY, ALCOHOLIC CHRONIC-PANCREATITIS, CHRONIC CALCIFIC PANCREATITIS, PAINFUL CHRONIC-PANCREATITIS, ENZYME REPLACEMENT THERAPY, PLACEBO-CONTROLLED TRIAL, TERM-FOLLOW-UP
journal title
ACTA GASTRO-ENTEROLOGICA BELGICA
Acta Gastro-Enterol. Belg.
volume
77
issue
1
pages
47 - 65
Web of Science type
Article
Web of Science id
000341234500008
JCR category
GASTROENTEROLOGY & HEPATOLOGY
JCR impact factor
0.912 (2014)
JCR rank
71/76 (2014)
JCR quartile
4 (2014)
ISSN
0001-5644
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
6843614
handle
http://hdl.handle.net/1854/LU-6843614
date created
2015-06-23 11:52:43
date last changed
2016-12-19 15:38:05
@article{6843614,
  abstract     = {Chronic pancreatitis (CP) is an inflammatory disorder characterized by inflammation and fibrosis, resulting in a progressive and irreversible destruction of exocrine and endocrine pancreatic tissue. Clinicians should attempt to classify patients into one of the six etiologic groups according to the TIGARO classification system. MRI/MRCP, if possible with secretin enhancement, is considered the imaging modality of choice for the diagnosis of early-stage disease. In CP, pain is the most disabling symptom, with a significant impact on quality of life. Pain should be assessed using the Izbicki score and preferably treated using the {\textacutedbl}pain ladder{\textacutedbl} approach. In painful CP, endoscopic therapy (ET) can be considered as early as possible. This procedure can be combined with extracorporeal shock-wave lithotripsy (ESWL) in the presence of large ({\textrangle} 4 mm), obstructive stone(s) in the pancreatic head, and with ductal stenting in the presence of a single main pancreatic duct (MPD) stricture in the pancreatic head with a markedly dilated MPD. Pancreatic stenting should be pursued for at least 12 months in patients with persistent pain relief. On-demand stent exchange should be the preferred strategy. The simultaneous placement of multiple, side-by-side, pancreatic stents can be recommended in patients with MPD strictures persisting after 12 months of single plastic stenting. 
We recommend surgery in the following cases : a) technical failure of ET; b) early (6 to 8 weeks) clinical failure; c) definitive biliary drainage at a later time point; d) pancreatic ductal drainage when repetitive ET is considered unsuitable for young patients; e) resection of an inflammatory pancreatic head when pancreatic cancer cannot be ruled out; f) duodenal obstruction. Duodenopan-createctomy or oncological distal pancreatectomy should be considered for patients with suspected malignancy. Pediatricians should be aware of and systematically search for CP in the differential diagnosis of chronic abdominal pain. As malnutrition is highly prevalent in CP patients, patients at nutritional risk should be identified in order to allow for dietary counseling and nutritional intervention using oral supplements. Patients should follow a healthy balanced diet taken in small meals and snacks, with normal fat content. Enzyme replacement therapy is beneficial to symptomatic patients, but also in cases of subclinical insufficiency. Regular follow-up should be considered in CP patients, primarily to detect subclinical maldigestion and the development of pancreatogenic diabetes. Screening for pancreatic cancer is not recommended in CP patients, except in those with the hereditary form.},
  author       = {Delhaye, Myriam and Van Steenbergen, Werner and Cesmeli, Ercan and Pelckmans, Paul and Putzeys, Virginie and Roeyen, Geert and Berrevoet, Frederik and Scheers, Isabelle and Ausloos, Floriane and Gast, Pierrette and Ysebaert, Dirk and Plat, Laurence and van der Wijst, Edwin and Hans, Guy and Arvanitakis, Marianna and Deprez, Pierre H},
  issn         = {0001-5644},
  journal      = {ACTA GASTRO-ENTEROLOGICA BELGICA},
  keyword      = {DUODENUM-PRESERVING RESECTION,QUALITY-OF-LIFE,RANDOMIZED CONTROLLED-TRIAL,SHOCK-WAVE LITHOTRIPSY,ALCOHOLIC CHRONIC-PANCREATITIS,CHRONIC CALCIFIC PANCREATITIS,PAINFUL CHRONIC-PANCREATITIS,ENZYME REPLACEMENT THERAPY,PLACEBO-CONTROLLED TRIAL,TERM-FOLLOW-UP},
  language     = {eng},
  number       = {1},
  pages        = {47--65},
  title        = {Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment},
  volume       = {77},
  year         = {2014},
}

Chicago
Delhaye, Myriam, Werner Van Steenbergen, Ercan Cesmeli, Paul Pelckmans, Virginie Putzeys, Geert Roeyen, Frederik Berrevoet, et al. 2014. “Belgian Consensus on Chronic Pancreatitis in Adults and Children: Statements on Diagnosis and Nutritional, Medical, and Surgical Treatment.” Acta Gastro-enterologica Belgica 77 (1): 47–65.
APA
Delhaye, Myriam, Van Steenbergen, W., Cesmeli, E., Pelckmans, P., Putzeys, V., Roeyen, G., Berrevoet, F., et al. (2014). Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment. ACTA GASTRO-ENTEROLOGICA BELGICA, 77(1), 47–65.
Vancouver
1.
Delhaye M, Van Steenbergen W, Cesmeli E, Pelckmans P, Putzeys V, Roeyen G, et al. Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment. ACTA GASTRO-ENTEROLOGICA BELGICA. 2014;77(1):47–65.
MLA
Delhaye, Myriam, Werner Van Steenbergen, Ercan Cesmeli, et al. “Belgian Consensus on Chronic Pancreatitis in Adults and Children: Statements on Diagnosis and Nutritional, Medical, and Surgical Treatment.” ACTA GASTRO-ENTEROLOGICA BELGICA 77.1 (2014): 47–65. Print.