Table.

Summary of complications associated with chronic pancreatitis.

Chronic pancreatitis – related diabetes mellitus (CP-DM)	•Lifetime prevalence: up to 180% (point prevalence is ~40%) •Annual screening for DM is recommended. •Most patients will ultimately require insulin therapy, although metformin may be useful for mild hyperglycemia.
Exocrine pancreatic insufficiency (EPI)	•Lifetime prevalence: >70% •Accurate and convenient diagnostic testing methods do not exist, so ask about potential symptoms at each visit. •When performed, fecal elastase-1 should be measured in a formed stool specimen. •Initiate pancreatic enzyme replacement therapy at a dose of 25,000 to 50,000 units of lipase with meals, then titrate based on clinical response (including symptoms, body weight, and vitamin and nutritional markers).
Metabolic bone disease (CP-associated osteopathy)	•Point prevalence: ~ 66% (includes both osteoporosis and osteopenia) •Consider baseline DXA screening for all patients. •Manage according to general principles.
Pancreatic cancer	•Lifetime prevalence: ~ 4-5% •Screening is not universally recommended. •Maintain a high index of clinical suspicion for all patients, and consider periodic imaging for those with additional, strong risk factors. •Changes on imaging can be challenging to interpret, so comparison to baseline scans is needed.
Anatomic complications:	•Prevalence: estimates are imprecise.
Splanchnic vein thrombosis	•Splenic vein is most commonly involved vessel. •Anticoagulation is unlikely to provide clinical benefit. •Options for management of bleeding gastric varices include endoscopic intervention or splenectomy (for splenic vein thrombosis).
Pseudocyst	•Asymptomatic pseduocysts should be observed. •Symptomatic pseudocysts can typically be managed with endoscopic cystgastrostomy, but may require surgical drainage.
Duodenal obstruction	•Typically requires surgical bypass.
Biliary obstruction	•Can be successfully treated with serial endoscopic stent placement, but refractory cases require surgical biliary bypass.