Treatment

The management of CP could be divided into drug therapy，surgical or endoscopic intervention.The great French physiologist，Claude Bernard（1813-1878）demonstrated the role of pancreatic secretion in the digestion of protein，carbohydrate and fat by injecting mutton fat into the pancreatic ducts of dogs（DiMagno 1993），an experiment that helped to spawn research into pancreatic exocrine replacement therapy.In 1868，Alexander Fles used fresh pancreatic tissue homogenate to alleviate the symptoms of fat diarrhea（Modlin 2003）.At the end of the nineteenth century and the beginning of the twentieth century，Langdon Down，von Noorden and Salomon extracted the fresh active ingredient in the pancreas to treat chronic diarrhea and steatorrhea successfully.Over the past few decades，the use of an enzyme mixture extracted from porcine pancreas（trypsin，lipase and amylase）has been widely accepted for the treatment of exocrine deficiency and steatorrhea in CP patients.Employing modern separation techniques，the current clinical application of pancreatic enzymes generally contains high concentrations of enzymes，can tolerate acid inactivation and release to be in sync with normal food digestion in the duodenum.

Surgical treatment is an effective and irreplaceable option for selected CP patients.Surgical treatment of CP can be divided into two types:pancreatectomy and decompression drainage.In 1935，Whipple，Parsons and Mullins（Whipple et al.1935）began work on their procedure for resection of the pancreas（pancreaticoduodenectomy）.In 1940，they shortened the procedure from a two-stage to a one-stage process.The key improvement lay in employing bile duct jejunum anastomosis instead of gallbladder stomach anastomosis，and this remains a landmark in pancreatic surgery.In 1954，to resolve the pancreatic hypertension problem in patients with CP，DuVal and Zollinger independently performed main pancreatic duct decompression（Duval 1954）.In 1891，Alfred Pearce Gould became the first surgeon to remove pancreatic stones from the duct of Wirsung（Hess 1912），which was found to alleviate the pressure of pancreatic duct thereby ameliorating the disease process.(https://www.daowen.com)

Stoneextraction was widely applied as part of the surgical treatment of CP until the advent of endoscopy and shock-wave lithotripsy（ESWL）.In 1973 and 1974，endoscopic sphincterotomy（EST）was reported by Kawai and colleagues（1974）and Classen and Demling（1974）respectively，and represents the basic technology underpinning pancreatic endoscopic treatment.In 1983，Seigel（Seigel 1983）successfully performed pancreatic duct stenting in patients with pancreatic duct stricture.In 1980，Chaussy（Chaussy et al.1980）performed high-energy shock waves to disintegrate kidney stones in both dogs and human.Thereafter，Sauerbruch and collegues（1987）disintegrated a pancreatic duct stone with ESWL in a patient with chronic pancreatitis.

Over the past 20 years，with the development of endoscopic techniques，dilatation of the pancreatic duct，extraction of pancreatic duct stones，and drainage of pseudocysts are now widely used in pancreatic interventional therapy.With recent developments in pancreatic surgery and the use of endoscopic technology，the treatment of CP has made great strides.In the future，with the further elucidation of the etiology and pathogenesis of CP，patients with CP should receive earlier diagnosis，improved treatment with better prognosis.