Secondary prevention

The American College of Gastroenterology states that there is no definitive benefit to screening patients with chronic pancreatitis for pancreatic ductal adenocarcinoma, even in those at high risk for pancreatic malignancy due to genetic or environmental risk factors.[85]

The American Gastroenterological Association recommends that pancreatic cancer screening should be considered in patients with hereditary pancreatitis; screening should be initiated at age 40 years in CKDN2A and PRSS1 mutation carriers with hereditary pancreatitis.[259]

International and UK guidelines recommend that patients with hereditary pancreatitis with inherited PRSS1 mutations should undergo surveillance for pancreatic cancer.[260][261]

Recommended screening and surveillance tests are endoscopic ultrasonography (EUS) or magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP).

One randomised controlled trial of patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy for pancreatic stones >5 mm in diameter reported that administration of rectal indometacin before the procedure reduced the risk of post-procedure pancreatitis, compared with placebo.[262]

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