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Interpretation of 2025 American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: methodology and review of evidence
Received date: 2025-05-02
Revised date: 2025-07-08
Accepted date: 2025-08-12
Online published: 2025-09-09
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.
Key words: Chronic pancreatitis; Pain; Endoscopy; Guideline interpretation
BAI Yaya , ZHOU Chunhua , ZOU Duowu . Interpretation of 2025 American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: methodology and review of evidence[J]. Journal of Diagnostics Concepts & Practice, 2025 , 24(04) : 407 -414 . DOI: 10.16150/j.1671-2870.2025.04.007
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