疼痛是慢性胰腺炎（chronic pancreatitis， CP）患者的主要症状之一，消化内镜在缓解CP患者的疼痛方面具有重要作用，但其临床应用仍存在诸多亟待解决的争议性问题。因此，为提供最佳实践建议，以帮助规范CP患者管理、改善治疗效果并减少实践中的差异性，美国胃肠内镜学会（American Society for Gastrointestinal Endoscopy， ASGE）基于广泛的文献回顾，以高质量的研究证据为基础，制定并发布了《消化内镜在慢性胰腺炎管理中的作用指南》（以下简称指南）。该指南分为“总结和推荐”和“方法学及证据回顾”两部分，分别发表于2024年和2025年。指南阐述了内镜治疗对缓解CP疼痛的有效性，涵盖了腹腔神经丛阻滞（celiac plexus block， CPB）、胰管结石与狭窄的内镜治疗，以及良性胆道狭窄和胰腺假性囊肿等不良事件的处理。指南就疼痛性CP患者采用内镜治疗或外科治疗，CPB治疗疼痛性CP患者时，采用超声内镜引导还是经皮方式，伴有主胰管结石的疼痛性CP患者内镜诊疗方式的选择，伴有主胰管狭窄的疼痛性CP患者内镜治疗时支架放置的种类、大小及数量，合并良性胆道狭窄的CP患者应当放置多个塑料支架还是金属支架，以及合并症状性假性囊肿的CP患者引流方式选择等6个临床核心问题，进行了证据回顾、总结和推荐。本文就2025年ASGE发布的《消化内镜在慢性胰腺炎管理中的作用指南：方法学及证据回顾》进行详细解读，深入了解指南的证据基础，突出有待解决的问题，为临床提供参考及进一步的研究方向。

Pain is one of the primary symptoms of patients with chronic pancreatitis (CP). Digestive endoscopy plays a significant role in alleviating pain in CP patients, but its clinical application is still associated with numerous unresolved controversial issues. Therefore, to provide the best practice recommendations to help standardize the management of CP patients, improve treatment outcomes, and reduce variability in clinical practice, the American Society for Gastrointestinal Endoscopy (ASGE) developed and published the Guideline on the role of endoscopy in the management of chronic pancreatitis (hereinafter referred to as the Guideline) based on an extensive literature review and high-quality research evidence. The Guideline is divided into two parts: "summary and recommendations" and "methodology and review of evidence", which were published in 2024 and 2025, respectively. The Guideline outlines the effectiveness of endoscopic therapies for pain relief in CP patients, including celiac plexus block (CPB), endoscopic management of pancreatic duct stones and strictures, and the treatment of adverse events such as benign biliary strictures (BBSs) and pancreatic pseudocysts. It reviews, summarizes, and provides recommendations on six key clinical issues: whether endoscopic or surgical treatment should be used for painful CP patients; whether endoscopic ultrasound-guided or percutaneous approaches should be preferred for CPB in painful CP patients; the choice of endoscopic diagnostic and therapeutic methods for painful CP patients with main pancreatic duct stones; the type, size, and number of stents to be placed during endoscopic therapy for painful CP patients with main pancreatic duct (MPD) strictures; whether multiple plastic stents or metal stents should be placed in CP patients with benign biliary strictures; and the selection of drainage methods for CP patients with symptomatic pseudocysts. This study provides a detailed interpretation of the Guideline on the role of endoscopy in the management of chronic pancrea-titis: methodology and review of evidence, published by ASGE in 2025. It aims to deepen the understanding of the Guideline's evidence base, highlight unresolved issues, and offer clinical guidance and directions for further research.