A Primer of Pancreatitis by Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler,

By Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler, Prof. Dr. med. J. Mössner, Prof. Dr. S. Müller-Lissner (auth.)

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If the cyst recurs drainage can be attempted by endoscopic stent placement after previous localisation with endoscopic ultrasound and/or CT. Gastric or duodenal drainage is performed if the cyst(s) have direct contact to the gastric or duodenal wall, respectively. Transpapillary drainage may be used if the cyst(s) communicate with the main pancreatic duct. Stents may be removed after one to three months. In cases with difficult access percutaneous drainage is preferred. Pancreatic stones The extraction of pancreatic duct stones may improve pain and probably slow the progressive loss of pancreatic function.

Normal serum pancreatic enzyme values do not exclude chronic pancreatitis. Elevated serum enzymes do not prove an acute episode, and may indicate pseudocysts even in asymptomatic patients. Direct pancreatic function tests. They are very sensitive and specific, but invasive and require much effort. Indirect pancreatic function tests. The assay of the stool enzymes chymotrypsin and elastase-I, the pancreolauryl test and the NBT-PABA test usually detect only moderately severe and severe impairments of function.

Prognosis Very few patients die from chronic pancreatitis itself. The main causes of death are cardiovascular diseases and malignant tumours. 38 Incidence, course and prognosis % of patients lOa 50 Functional impairment req uiring pancreatic enzyme supplementation or insul in O__+-__________________~ lr~ ea ~t~ m ~e ~n ~t________~----- o Yea rs 10 Mortality 20% over 10 years 39 Chronic pancreatitis Diagnosis: overview Functional examinations The morphological alterations and the functional impairment do not run in parallel.

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