Endoscopic Care for Chronic Pancreatitis: 2025 American Guidelines

 
Chronic pancreatitis (CP) is a long-term condition affecting the pancreas, a vital organ responsible for digestion and blood sugar control. At Bumrungrad International Hospital, we are committed to providing the latest, most effective treatments for this complex disease.
 
In 2025, the American Society for Gastrointestinal Endoscopy (ASGE) released newly updated, evidence-based guidelines on endoscopic management of chronic pancreatitis. Developed by experts from top institutions—including Harvard Medical School, Mayo Clinic, and Johns Hopkins University—these recommendations highlight how endoscopic therapy is now central to treating CP.
 
This blog breaks down the 2025 guidelines in a detailed yet patient-friendly way, helping you understand your options and make informed decisions.
 

What Is Chronic Pancreatitis (CP)?
Chronic pancreatitis is a progressive and irreversible inflammatory condition of the pancreas. Over time, it leads to scarring and loss of function, which may result in:

• Persistent abdominal pain
• Digestive problems due to exocrine insufficiency
• Diabetes mellitus from endocrine insufficiency
• Complications like bile duct strictures, pancreatic duct stones, and pseudocysts

Pain in CP is often complex and multifactorial. In many cases, blockage of the pancreatic duct (PD) causes high pressure and inflammation, significantly contributing to symptoms.
 

How Can Endoscopy Help in Chronic Pancreatitis (CP)?
Endoscopy is a minimally invasive technique using a camera-equipped tube inserted through the mouth to examine and treat the pancreas from the inside. The 2025 ASGE guidelines clarify when and how endoscopic treatment is most effective for chronic pancreatitis patients.
 
Let’s explore the latest expert-backed recommendations:
 
1. Endoscopy vs. Surgery for Painful Chronic Pancreatitis (CP) with Blocked Pancreatic Duct
If your main pancreatic duct is blocked and you experience pain:

• Surgery should be considered first, especially if you are a good surgical candidate.
• Endoscopy is recommended for patients who prefer a less invasive option or are not suitable for surgery due to medical risks.

Takeaway: Endoscopy is a valuable alternative to surgery in selected patients.
 
2. Celiac Plexus Block (CPB) for Pain Management
A celiac plexus block (CPB) is a procedure used to reduce severe pain by numbing nerves near the pancreas.

• The EUS-guided approach (using endoscopic ultrasound) is now preferred over the older percutaneous method.

Takeaway: EUS-guided blocks are safer, more targeted, and offer better outcomes.
 
3. Pancreatic Duct Stones: What’s the Best Approach?
If you have stones in your pancreatic duct, treatment depends on several factors:

• Size of the stone
• Location of the stone
• Whether the stone is radiopaque (visible on X-ray)

General Recommendations:

• For stones larger than 5 mm in the head or body of the pancreas:
  • ESWL (extracorporeal shock wave lithotripsy) is the first step.
  • If stones remain after fragmentation, follow up with ERCP (endoscopic retrograde cholangiopancreatography), with or without pancreatoscopy.
• For smaller stones or if ESWL is unsuitable:
  • Proceed directly with ERCP.

Takeaway: A combination of ESWL and endoscopy offers effective relief in many cases.
 
4. Treating Pancreatic Duct Strictures with Stents
Strictures (narrowed areas) of the pancreatic duct can be managed with stents. The new 2025 guidelines recommend:

• Starting with a single large plastic stent
• Using the largest diameter stent that can be safely placed
• Avoiding metal stents unless absolutely necessary

Takeaway: A simpler stent approach is safer and often just as effective.
 
5. Treating Biliary Strictures in Chronic Pancreatitis Patients
Some patients develop bile duct narrowing due to CP, leading to jaundice or liver dysfunction. The best approach is:

• Use fully covered self-expandable metal stents (FCSEMSs) instead of multiple plastic stents.

Takeaway: Metal stents provide superior outcomes in these cases.
 
6. Treating Pancreatic Pseudocysts
Pseudocysts are fluid-filled sacs that may form as a result of chronic pancreatitis. If symptomatic, the best management is:

• Endoscopic drainage rather than surgery.

Takeaway: Endoscopic drainage is less invasive, with high success rates.
 

Why Choose Bumrungrad International Hospital?
At Bumrungrad, we provide a comprehensive and multidisciplinary approach to chronic pancreatitis, offering:

• Advanced ERCP techniques
• Pancreatoscopy
• ESWL (Extracorporeal Shock Wave Lithotripsy)
• Laser lithotripsy
• EUS-guided therapies
• A pancreas-focused team that includes international pancreatic surgeons, interventional radiologists, GI pathologists, and clinical dietitians

 
Putting the Guidelines into Action
Chronic pancreatitis can significantly reduce your quality of life—but effective, guideline-backed treatment is available. Whether it’s advanced imaging, endoscopic drainage, or tailored pain relief, the 2025 American guidelines offer a clear roadmap for managing complex chronic pancreatitis cases.
 
If you’re experiencing persistent symptoms or looking for a second opinion, the experts at Bumrungrad International Hospital’s Digestive Disease Center are ready to help.
 
 
Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital