Endoscopic Management of Benign Pancreatic Stricture Associated with Chronic Pancreatitis

The most common symptom of chronic pancreatitis is abdominal pain. Potential causes include ductal hypertension due to pancreatic stricture, bile duct stricture, duodenal stricture, the presence of a pseudocyst, and increased nociception. In the management of main pancreatic ductal strictures associated with chronic pancreatitis, an endoscopic pancreatic sphincterotomy is typically performed, followed by stricture dilation and the insertion of a single plastic stent. If pancreatic stones are present, extracorporeal shockwave lithotripsy may also be necessary. After placing a plastic stent in the pancreatic duct, regular stent exchanges should be performed, maintaining stenting for approximately 1 year. For refractory pancreatic ductal stricture, the placement of multiple plastic stents or a fully covered metal stent may be considered. Although metal stents are effective, they are associated with a higher risk of adverse events, including stent migration, bile duct obstruction, and the formation of de novo pancreatic ductal strictures. This review discusses the endoscopic management of benign pancreatic ductal stricture associated with chronic pancreatitis.