ENDOSCOPIC MANAGEMENT Endoscopictechniques are used increasingly in the management of acute and chronic
pancreatitis. Management
of patients with acute recurrent and chronic
pancreatitis is hampered by our incomplete understanding of the pathogenesis of pancreatic inflammation and mechanism of pancreatic pain. The short termassessment of therapies is made more difficult due to the relapsing andremitting nature of pain in pancreatic disease. Therefore, a detailedunderstanding of the natural history of pancreatitis is required prior tounder taking endoscopic treatment of pancreatic diseases.Pancreatitisis an inflammatory condition of the pancreas that is painful and at times deadly. BILIARY PANCREATITIS Gallstone disease is one of the most common causes of acute pancreatitis. The mechanism by which patients with severe pancreatitis benefit from ERCP isunclear as ERCP cannot reverse the damage already done to the pancreas. Fluid can also be aspirated by endoscopists who are trained in the technique ofendoscopic ultrasound (EUS) and the insertion of a needle through either the wall of the stomach or the duodenum. If the characteristics of the fluid are indicative of a mucinous neoplasm, most patients then undergo surgery to remove the portion of the pancreas that contains this tumor because it is eitheralready malignant or may become malignant in the future. These are examples of presentations of the same illness – chronic pancreatitis. Acute pancreatitis is the sudden onset of inflammation and tissue destruction of the pancreas that may even involve other organ systems. The pancreas usually heals over time, and the damage is not permanent. Chronic pancreatitis involves long-term inflammation andscarring of the pancreas that is irreversible. Pain is one of the diagnostic features of acute pancreatitis, but may be absent in chronic pancreatitis. Pancreatic insufficiency is when the pancreas is unable to produce enough digestive enzymes to break down and absorb food in the intestine. The diagnosis of chronic pancreatitis may require several tests. The care and advice of a "pancreatologist", agastroenterologist or surgeon with expertise in pancreatic diseases, is ofutmost importance. Hope lies in continued research of the causes and potential treatments of chronic pancreatitis, and in education and public awareness of the disease. Generally, the goal has been to “rest” the pancreas byminimizing oral in take and treating the pain with medication. With the current support of the Cystic Fibrosis Foundation, our goal is to advance this researchin order to proceed to clinical trials in patients. Lastly, in an ongoing research study, we have addressed the issue of nutrition in patients with chronic pancreatitis. While many people with chronic pancreatitis are aware of the need for fat restriction, few are aware of the need for adequate hydration. While the exact reason is not known at this time,it is assumed that the lack of fluid assists in the accumulation of pancreaticsludge.