Chronic Pancreatitis

Question 1

Recommend CT or MRI for the first-line diagnosis of CP. Either test should be the first choice for the diagnosis of CP. EUS, because of its invasiveness and lack of specificity, should be used only if the diagnosis is in question after cross-sectional imaging is performed

Answer 1

strong, low evidence

Question 2

Suggest performing s-MRCP when the diagnosis of CP following cross-sectional imaging or EUS is not confirmed and the clinical suspicion remains high

Answer 2

conditional, low evidence

Question 3

Suggest histological examination as the gold standard to diagnose CP in high-risk patients when the clinical and functional evidence of CP is strong, but imaging modalities are inconclusive

Answer 3

conditional, very low evidence

Question 4

Recommend genetic testing in patients w/ clinical evidence of a pancreatitis-associated disorder or possible CP in which the etiology is unclear, especially in younger patients

Answer 4

strong, low evidence

Question 5

Recommend alcohol and smoking cessation

Answer 5

strong, very low evidence

Question 6

Recommend surgical intervention over endoscopic therapy in patients w/ obstruction CP for the long-term relief of pain if first-line endoscopic approaches to pancreatic drainage have been exhausted or unsuccessful

Answer 6

strong, moderate evidence

Question 7

Suggest considering the use of antioxidant therapy for CP w/ pain, although the benefit of pain reduction is likely limited

Answer 7

conditional, moderate evidence

Question 8

We do not suggest the use of pancreatic enzyme supplements to improve pain in CP

Answer 8

conditional, low evidence

Question 9

Suggest considering celiac plexus block for treatment of pain in CP

Answer 9

conditional, very low evidence

Question 10

Suggest PERT in patients w/ CP and exocrine pancreatic insufficiency to improve the complications of malnutrition

Answer 10

conditional, low evidence