A number of endoscopic interventions have expanded the range of treatment options in symptomatic
pancreatic diseases. Early endoscopic retrograde cholangiopancreatography (ERCP) and
endoscopic sphincterotomy (ES) appear to be beneficial in patients with severe acute biliary
pancreatitis. Endoscopic pancreatic
sphincterotomy can be safely performed with high technical success rates in patients with
chronic pancreatitis. Routine additional biliary ES or drainage procedures are not apparently necessary. Stenting can be limited to the treatment of dominant pancreatic duct
strictures. In patients with
sphincter of Oddi dysfunction, temporary placement of pancreatic
stents reduces the morbidity associated with ES. Transpapillary or transmural endoscopic drainage achieves resolution of
pancreatic pseudocysts in the majority of selected patients. Drainage procedures with endoscopic ultrasound guidance can potentially expand the indications and reduce the procedure-related morbidity. Therapeutic endoscopy should be considered in symptomatic patients with
pancreas divisum, as well as in selected children with
pancreatic diseases. Most of the published studies on therapeutic pancreatic endoscopy have been conducted retrospectively. Additional prospective controlled trials are warranted to allow further evaluation of the impact of these methods on the clinical outcome in comparison with alternative treatment strategies.