Systematic literature search to answer explicit key questions with levels of evidence serving to determine recommendation grades. The ESGE funded development of the Guideline.
SUMMARY OF SELECTED RECOMMENDATIONS: For treating painful uncomplicated
chronic pancreatitis, the ESGE recommends
extracorporeal shockwave lithotripsy/endoscopic retrograde cholangiopancreatography as the first-line interventional option. The clinical response should be evaluated at 6 - 8 weeks; if it appears unsatisfactory, the patient's case should be discussed again in a multidisciplinary team. Surgical options should be considered, in particular in patients with a predicted poor outcome following endoscopic
therapy (Recommendation grade B). For treating
chronic pancreatitis associated with radiopaque stones ≥ 5 mm that obstruct the main pancreatic duct, the ESGE recommends
extracorporeal shockwave lithotripsy as a first step, combined or not with endoscopic extraction of stone fragments depending on the expertise of the center (Recommendation grade B). For treating
chronic pancreatitis associated with a dominant
stricture of the main pancreatic duct, the ESGE recommends inserting a single 10-Fr
plastic stent, with
stent exchange planned within 1 year (Recommendation grade C). In patients with ductal
strictures persisting after 12 months of single
plastic stenting, the ESGE recommends that available options (e. g., endoscopic placement of multiple pancreatic
stents, surgery) be discussed in a multidisciplinary team (Recommendation grade D).For treating uncomplicated chronic
pancreatic pseudocysts that are within endoscopic reach, the ESGE recommends endoscopic drainage as a first-line
therapy (Recommendation grade A).For treating
chronic pancreatitis-related biliary
strictures, the choice between endoscopic and surgical
therapy should rely on local expertise, patient co-morbidities and expected patient compliance with repeat endoscopic procedures (Recommendation grade D). If endoscopy is elected, the ESGE recommends temporary placement of multiple, side-by-side,
plastic biliary
stents (Recommendation grade A).