Endotherapy for complications of pancreatitis: ready for prime time.

Acute and chronic pancreatitis may lead to local complications as a result of ductal injury. In the setting of acute pancreatitis the main pancreatic duct or its side branches may be disrupted. These ductal injuries can be minimal and associated with leakage of only fluid, or severe with necrosis of a large amount of pancreatic parenchyma along with the duct lying in the same area.1,2 The sequela of these disruptions is the development of pancreatic pseudocysts or organized necrotic pancreatic collections. When these types of collections become symptomatic (e.g., abdominal pain, pressure on surrounding structures with resultant gastric outlet obstruction, infection, and ascites) drainage is usually required. Chronic pancreatitis can produce scarring and obstruction of the main pancreatic duct, frequently in association with obstructing calculi. The pancreatic duct upstream to the obstruction continues to secrete pancreatic juice. The subsequent pressure may produce a ductal blowout (leak) with pseudocyst formation, pancreatic ascites or pancreatic fistula.2 Ductal obstruction can also produce acute pancreatitis in the obstructed pancreatic segment and can be acute in chronic pancreatitis. Finally, worsening of chronic abdominal pain may also occur. All these complications of chronic pancreatitis may also require drainage.