EndoscopyMetabolic Impact of Pancreatic Duct Decompression

Inclusion Criteria:

1. Provision of signed and dated informed consent form
2. Stated willingness to comply with all study procedures and availability for the duration of the study
3. Male or female, aged ≥ 18
4. Chronic pancreatitis as defined by Cambridge grade 3 or 4 (3: > 3 abnormal side branches; 4: abnormal main duct and branches) pancreatic ductal changes and/or parenchymal and/or intraductal calcifications (chronic calcific pancreatitis) by CT Scan or MRI/MRCP24
5. Minimally symptomatic:

• Asymptomatic patients who were incidentally diagnosed with chronic pancreatitis based on imaging
• Mild to moderate pain (visual analog scale ≤ 5) who do not require daily opioid pain medications
• ≤ 1 episode of uncomplicated acute pancreatitis in 12 months prior to enrollment

Exclusion Criteria:

1. History of diabetes (defined as either a HbA1c ≥ 6.5 % or a fasting glucose ≥ 126 mg/dL)
2. Pancreatic duct obstruction limited to the tail of pancreas
3. Surgically altered forgot anatomy prohibitive of ERCP with standard techniques (e.g Billroth II, Roux-en-y gastric bypass, pancreaticoduodenectomy)
4. Prior pancreatic surgery
5. Pancreatic head mass or suspicion for pancreatic malignancy
6. Concurrent extra-pancreatic malignancy other than non-melanoma skin cancer
7. Prior endoscopic therapy for pancreatic duct obstruction
8. Acute pancreatitis < 90 days prior to enrollment
9. Active alcohol use within 2 months of enrollment
10. Gastrointestinal stricture/obstruction precluding passage of the duodenoscope to the papilla
11. Standard contraindications to ERCP
12. Unable to receive general anesthesia