Our goal in treating chronic pancreatitis is to support you and manage your pain. It is important that you abstain from alcohol and cigarettes. Patients who used alcohol and cigarettes reported a greater number of pain relapses.
Treatment options include:
For patients with chronic pain that cannot be controlled otherwise, we may recommend medication.
Analgesics are pain reducers. We will individualize your dose, starting you on the lowest effective dose. We will monitor you closely, increasing and decreasing your dosage as necessary.
We may recommend enzyme therapy to control diarrhea, reduce pain and help you gain weight. Enzyme therapy helps your body absorb nutrients.
High-protein, High-calorie Diets
Some patients develop protein energy malnutrition. Therapy for protein energy malnutrition requires correction of malabsorption and administration of high-protein, high-calorie diets. In severely malnourished chronic pancreatitis patients, total parenteral nutrition may be the preferred treatment.
When medical and endoscopic therapies have failed, we may recommend surgery. There are many surgical options. Different procedures work better for different patients. We will work closely with you to find the surgical approach that offers you the best outcome. The type of surgery depends on the severity of your pain, the extent of the disease and your overall health.
Surgical procedures include:
Puestow Procedure (Longitudinal Pancreaticojejunostomy)
The goal of this procedure is to clear the blocked pancreatic duct. It is successful in relieving pain in many patients.
Whipple Procedure (Pancreaticoduodenectomy)
During this surgery, your surgeon removes part of the pancreas, the duodenum (first part of the small intestine), part of the common bile duct, the gallbladder and possibly part of the stomach. Your surgeon then connects the remaining intestines. This is a complex procedure; only surgeons with extensive experience and training should perform the Whipple procedure.
Total Pancreatectomy and Auto Islet Transplantation
A total pancreatectomy and auto islet transplantation may be necessary for patients with chronic severe abdominal pain who do not respond to conventional treatment.
In the first part of the double procedure, the pancreas is surgically removed (called a total pancreatectomy).
When the pancreas is removed, auto islets (insulin-producing cells) found in the pancreas must be transplanted to the liver in order to reduce
s the need for insulin, which would otherwise be necessary for people without a pancreas.
Your surgeon resects (removes) part of the pancreas.
In the advanced stages of chronic pancreatitis, oral drugs may not be enough to control the pain. Your doctor may recommend a nerve block, which is an injection of an anesthetic around your nerve. The injection stops the nerves from sending pain messages.
This is a successful but short-term option for pain relief. Patients often require repeat treatments.
Your doctor may be able to treat chronic pancreatitis using endoscopic procedures.
Endoscopic procedures include:
Endoscopic Pancreatic Sphincterotomy
This helps reduce pressure on the pancreatic ducts. It also allows your doctor to:
- Place a pancreatic stent
- Take a tissue sample (biopsy)
- Dilate (open) a stricture (narrowed area)
- Remove stones
Treating strictures using an endoscopic approach is less invasive than a regular surgery. You may require more than one procedure to achieve or maintain a positive result. Opening the strictures will relieve pain associated with chronic pancreatitis.
Duct stones may obstruct the flow of pancreatic juices. Using endoscopy, your doctor can remove the stones. We may combine an endoscopic approach with extracorporeal shock wave lithotripsy (ESWL), a procedure that breaks up the stones before they are removed.
Chronic pancreatitis can cause complications in other parts of the body. Part of treating the disease is to treat and manage those complications. Depending on the complication and the severity, we can treat it endoscopically, surgically or using percutaneous therapy.
Biliary obstruction. Inflammation and scarring can affect the flow of bile through the bile ducts.
Pseudocysts. A pseudocyst forms when pancreatic fluids collect outside the ducts.
Duodenal obstruction. Chronic pancreatitis can cause the pancreatic and bile ducts to constrict, leading to an obstruction of the duodenum.
Pancreatic fistula. A pancreatic fistula is an abnormal opening coming from the pancreas or pancreatic duct.
Pancreatic Ascites. This is the abnormal collection of pancreatic fluids inside the abdomen.