Chronic pancreatitis

Chronic pancreatitis accounts for at least 80% of the burden of pancreatic disease, affecting the population with a prevalence of 100–150 per 100 000 of the population per annum. Systemic disease such as lupus, cystic fibrosis and hyperparathyroidism are all associated with chronic pancreatitis. Chronic pancreatitis is usually a patchy and focal pathological process. Pain is the most common presentation of chronic pancreatitis, occurring in up to 95% of patients, but becoming a less prevalent symptom with increasing age of presentation. One of the most difficult areas for diagnosis is the differentiation of pancreatic abnormalities due to pancreatitis or malignancy. The most common indication for surgical intervention in chronic pancreatitis is to relieve intractable pain. The endoscopic drainage of pseudocysts represents one of the more commonly performed and therapeutically satisfactory procedures. Modern lithotripters with fluoroscopic targetting can satisfactorily fragment stones within the pancreatic duct, allowing fragments and debris to pass through a relatively small pancreatic sphincterotomy.