The optimal treatment of pancreatic duct strictures and stones due to chronic pancreatitis remains challenging considering the heterogeneity in etiology, morphology and patient burden. Endoscopic therapy offers a minimally invasive option. However, endoscopic therapy, especially since the introduction of pancreatoscopy, varies between centers and countries due to availability and preference. Current guidelines offer limited guidance for treatment decisions. This study aims to provide an overview of practice variation across Europe and its influence on treatment outcomes, focusing on quality of life. 

This multicenter prospective snapshot study was conducted in 14 hospitals from 8 European countries. Between the 1^st of June 2021 and the 9^th of August 2023, patients undergoing endoscopic therapy for chronic pancreatitis were included. Patients were followed for at least 2 years. Primary outcomes were type of therapy performed and clinical success, defined as partial or complete pain relief following endoscopic therapy after 2 years. Secondary outcomes were total number of interventions, quality of life and post-interventional events. The Pancreatitis Quality of Life Instrument (PANQOLI), Izbicki and 12-Item Short-Form (SF-12) were performed at baseline and after 1, 3, 6, 12, 18 and 24 months post-intervention. 

96 patients were included (mean age 54 years (14.7), 66 (68.8%) men), median symptom duration of 7 months (3.0-23.0), 33 (34.4%) patients had current opioid use, of which 14 (42.4%) longer than 6 months and the most common etiology toxic/metabolic (N=49, 51.6%). The mean Izbicki score was 52.7 (SD 24.6) following 81 responses. The primary indication for intervention was pain (N=70, 56.5%). Overall, 102 treatments were performed, 6 patients receiving multiple modalities. Of these, 55 (53.9%) were only classic Endoscopic Retrograde Cholangiopancreatography (ERCPs), 23 (22.5%) extracorporeal shockwave lithotripsy (ESWL) +/- ERCP, 20 (19.6%) ERCPs assisted with pancreatoscopic lithotripsy and 4 (3.9%) Endoscopic ultrasound-guided access (i.e. rendezvous). A median of 3 (IQR 2.0-5.0) endoscopic interventions were performed in the two year follow-up. Clinical success following only endoscopic therapy was achieved in 56 (58.3%) patients. After 2 years, the median Izbicki score was 18.1 (IQR 1.2-33.9) in the overall population, following 36 responses. Nineteen patients used opioids (19.8%). Four patients died, one caused by endoscopic complications, one due to an infected pseudocyst and two following other/unknown causes. Additional pancreatic surgery was performed in 21 (21.9%) patients and planned in two (2.1%). Explorative univariate logistic regressions showed no correlation of treatment related factors and patient related factors on clinical success. Additional quality of life outcomes are currently being analyzed and results are expected beginning of 2026. 

This snapshot study shows substantial treatment variation across Europe, with currently a limited role for pancreatoscopic lithotripsy. This treatment variation in combination with a clinical success rate in about 6 out of 10 cases, underlines the need for standardization of endoscopic management of chronic pancreatitis. Although several studies have shown superior outcomes of surgery, minimally invasive endotherapy should not be dismissed. Future studies should focus on optimal patient selection, further standardizing endotherapy based on morphologic traits and creating unity in European treatment standards.