**1. Introduction**

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that may involve peripancreatic tissues and/or other remote organs, as part of a systemic inflammatory syndrome. It represents one of the most common causes of hospitalization for gastroenterological disorders [1].

The course of AP can be variable, with most patients showing a mild self-limited disease, requiring only supportive treatment. However, some patients still have a severe course, with a mortality rate of 10–20% [2]. Even if many factors, as intensive care unit intervention and early recognition and treatment of complications, have reduced mortality from AP over the past 20 years, the management of this disease remains challenging.


### **Table 1.**

*Indications and endoscopic modalities in chronic pancreatitis.*

*covered self-expandable metal stent; EUS, endoscopic ultrasonography.*

The aims of endoscopy in AP include investigation and treatment of the causal factors and management of local complications, such as organized pancreatic necrosis, ductal disruption, and pseudocysts.

Chronic pancreatitis (CP) is a syndrome characterized by chronic progressive pancreatic inflammation, fibrosis, and scarring, resulting in damage and loss of exocrine (acinar), endocrine (islet cells), and ductal cells [3].

Pain is the predominant symptom observed during the course of CP. The etiopathogenesis of pain in CP is multifactorial and includes not only ductal hypertension due to obstruction of the pancreatic duct (PD) (calculi or stricture) but also neuropathy, peripheral sensibilization, and local or systemic complications (pseudocyst or distal biliary obstruction) [4]. Both pain intensity and frequency of pain attacks reduce quality of life in patients with CP.

Endoscopic therapy in painful CP is based on the rationale that pain is related to an overflow obstruction of the main pancreatic duct (strictures or pancreatic intraductal stones): the mainstay of endoscopic treatment includes decompression of pancreatic duct with stents (plastic or metal stent) in those with stricture(s), and fragmentation of pancreatic duct stone(s) using endoscopic retrograde cholangiopancreatography (ERCP) and/or in combination with extracorporeal shock wave lithotripsy (ESWL). This is the reason why only selected cases of patients with CP are amenable to endoscopic treatment.

Endoscopic ultrasonography (EUS) has emerged as a complementary endoscopic modality in the management of CP as well as associated complications like pseudocysts, refractory pain, and vascular complications (**Table 1**).
