Endoscopic approaches to pancreatic disease.

PURPOSE OF REVIEW: Endoscopy plays a central role in the evaluation and management of patients with pancreatic disease. This review focuses on recent clinically relevant developments and timely research questions related to endoscopy in acute and chronic pancreatitis.

RECENT FINDINGS: Endoscopic ultrasound (EUS) has moved to the forefront of the evaluation of unexplained pancreatitis; endoscopic retrograde cholangiopancreatography (ERCP) for recurrent acute pancreatitis remains controversial but commonly practiced; fully covered metallic stents are challenging traditional stent therapy in the treatment of benign biliary and pancreatic strictures due to chronic pancreatitis; endoscopic drainage has become central in the therapeutic algorithm for pancreatic fluid collections; EUS-guided access to the pancreatic duct in cases of unsuccessful ERCP is a promising new platform that requires additional research and development. The evidence in these areas is discussed, with an emphasis on recent high-impact publications.

SUMMARY: There have been significant recent advances in our endoscopic approach to pancreatic disease; however, additional research is necessary toward providing high-quality, evidence-based care in this area.