{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 28, Ep 5 of 7: Recurrent Pancreatitis and Duct Decompression","html":"","width":"100%","height":180,"duration":651,"description":"Episode five holds EUS and ERCP to one standard in the pancreatitis spectrum: they earn their place only when there is structural disease or stone burden to act on, because every procedure carries a real pancreatitis risk weighed against a modest expected benefit. In the recurrent-attack workup, EUS for microlithiasis is the highest-yield study after MRCP, while sphincterotomy for divisum and idiopathic disease is the reflex sham-controlled data have humbled. In the chronic gland you decompress discrete obstructive lesions and read the true predictors of success, disease duration, cessation, and stone burden rather than head calcification. Standing over all of it, a randomized trial favors early surgical drainage for the painful dilated duct.\n \nTopics covered\n\nEUS and ERCP earn their place only with structural disease\nIdiopathic recurrent acute pancreatitis workup\nEUS for microlithiasis\nSphincter of Oddi manometry caution\nPancreas divisum and the sham-controlled trial\nChronic dilated duct and predictors of success\nESWL and pancreatic duct stone fragmentation\nDominant stricture stenting and surgery versus endoscopy\n \n \nKey decisions\n\nWork up idiopathic recurrent acute pancreatitis with history, calcium and triglycerides, MRCP, and IgG4 serologies, then EUS as the highest-yield test because it resolves microlithiasis that surface ultrasound misses.\nDo not reflexively perform ERCP with manometry after a negative workup; biliary sphincterotomy helps only about half the time even with elevated pressures, so reserve it for documented multiple recurrences with full prophylaxis.\nDo not offer routine minor papilla sphincterotomy for recurrent pancreatitis in pancreas divisum, since a sham-controlled trial showed no benefit and the tiny minor papilla carries higher post-procedure pancreatitis risk.\nPredict chronic-pancreatitis endotherapy success from short disease duration, smoking and alcohol cessation, limited stone burden, and achievable complete clearance, not from...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}