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  • Guideline Summary
  • NGC:005140
  • 2006 Jun (reaffirmed 2011)

The role of endoscopy in patients with chronic pancreatitis.

Adler DG, Lichtenstein D, Baron TH, Davila R, Egan JV, Gan SL, Qureshi WA, Rajan E, Shen B, Zuckerman MJ, Lee KK, VanGuilder T, Fanelli RD. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006 Jun;63(7):933-7. [55 references] PubMed External Web Site Policy

View the original guideline documentation External Web Site Policy

This is the current release of the guideline.

The guideline was reaffirmed for currency by the developer in 2011.

Major Recommendations

The levels of evidence (I–V) and strength of recommendations (A–C) are defined at the end of the "Major Recommendations" field.

Summary

  • Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are useful for the diagnosis of chronic pancreatitis (CP) and associated pancreatic ductal complications (B).
  • ERCP for the diagnosis of CP should be reserved for patients in who the diagnosis has not been established by noninvasive or less-invasive studies (C).
  • Endoscopic therapy of pancreatic ductal obstruction can provide short-term relief of abdominal pain and long-term relief in some patients (B).
  • ERCP is effective for the short-term treatment of common bile duct obstruction resulting from CP (B) and long-term treatment in poor operative candidates (C).
  • Endoscopically placed pancreatic duct stents are effective for the nonsurgical management of pancreatic strictures, duct leaks, and disruptions (B).
  • EUS-guided celiac blockade can effectively provide short-term pain relief in patients with CP (B).

Definitions:

  1. Prospective controlled trials
  2. Observational studies
  3. Expert opinion

Clinical Algorithm(s)

None provided

Disease/Condition(s)

Chronic pancreatitis

Guideline Category

Assessment of Therapeutic Effectiveness

Diagnosis

Management

Treatment

Clinical Specialty

Family Practice

Gastroenterology

Internal Medicine

Intended Users

Physicians

Guideline Objective(s)

To review the role of endoscopy in the management of chronic pancreatitis (CP)

Target Population

Patients with chronic pancreatitis

Interventions and Practices Considered

  1. Endoscopic retrograde cholangiopancreatography (ERCP)
  2. Endoscopic ultrasonography (EUS)
  3. Endoscopic therapy of pancreatic ductal obstruction
  4. Endoscopic placement of pancreatic duct stents
  5. EUS-guided celiac blockade

Major Outcomes Considered

  • Sensitivity and specificity of diagnostic tests
  • Symptom improvement
  • Therapeutic efficacy

Methods Used to Collect/Select the Evidence

Hand-searches of Published Literature (Primary Sources)

Hand-searches of Published Literature (Secondary Sources)

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

A MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

2011 Currency Review Process

A review of citations from the previous guideline was augmented with searches of electronic databases including MEDLINE, PubMed, CINAHL, Embase, and Cochrane, along with review of proceedings from national meetings since 2005. The date range for all searches was from the time of the last update (2005) through 2010 inclusive. Topics searched included endoscopy and chronic pancreatitis.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

Expert Consensus

Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence

Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

Expert Consensus

Description of Methods Used to Formulate the Recommendations

2006 Guideline

Not stated

2011 Currency Review Process

The American Society for Gastrointestinal Endoscopy Standards of Practice Committee reviewed this guideline in August 2011. An update is anticipated in 2012.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

Not stated

Description of Method of Guideline Validation

Not applicable

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and classified for the recommendations using the following scheme:

  1. Prospective controlled trials
  2. Observational studies
  3. Expert opinion

When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus.

Potential Benefits

Appropriate and effective use of endoscopy for diagnosis and treatment in patients with chronic pancreatitis

Potential Harms

Complications related directly to endoscopic therapy of pancreatic duct (PD) strictures include pain, pancreatitis, stent occlusion, proximal or distal stent migration, duodenal erosions, pancreatic infection, ductal perforation, stone formation, and bleeding (if sphincterotomy is performed).

Qualifying Statements

Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Description of Implementation Strategy

An implementation strategy was not provided.

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Bibliographic Source(s)

Adler DG, Lichtenstein D, Baron TH, Davila R, Egan JV, Gan SL, Qureshi WA, Rajan E, Shen B, Zuckerman MJ, Lee KK, VanGuilder T, Fanelli RD. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006 Jun;63(7):933-7. [55 references] PubMed External Web Site Policy

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

2006 Jun (reaffirmed 2011)

Guideline Developer(s)

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

Source(s) of Funding

American Society for Gastrointestinal Endoscopy

Guideline Committee

Standards of Practice Committee

Composition of Group That Authored the Guideline

Committee Members: Douglas G. Adler, MD; David Lichtenstein, MD; Todd H. Baron, MD (Chair); Raquel Davila, MD; James V. Egan, MD; Seng-Ian Gan, MD; Waqar A. Qureshi, MD; Elizabeth Rajan, MD; Bo Shen, MD; Marc J. Zuckerman, MD; Kenneth K. Lee, MD (NAPSGHAN Representative); Trina VanGuilder, RN (SGNA Representative); Robert D. Fanelli, MD (SAGES Representative)

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

The guideline was reaffirmed for currency by the developer in 2011.

Guideline Availability

Electronic copies: Available in Portable Document Format (PDF) from the American Society for Gastrointestinal Endoscopy Web site External Web Site Policy.

Print copies: Available from the American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523

Availability of Companion Documents

None available

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI on October 9, 2006. The information was verified by the guideline developer on October 31, 2006. The currency of the guideline was reaffirmed by the developer in 2011 and updated by ECRI Institute on November 3, 2011.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

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