Early endoscopic treatment of blunt traumatic pancreatic injury

Abstract

Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

Clinical update on management of pancreatic trauma

“…The literature search identified several systematic reviews, consensus reports, registry studies and larger single and multicentre studies (Supplemental Figure 1). A systematic review was identified on the use of amylase as a laboratory test to diagnose pancreatic injury, 9 and on early use of endoscopic management, 10 and there were three consensus reports for management in adults. [11][12][13] Two systematic reviews 14,15 and one consensus report 16 on diagnosis and management in children were also identified.…”

“…3) and facilitate non-operative management by stenting and drainage in patients with delayed presentation of pseudocysts and collections. 66 Based on data in a systematic review, 10 it is suggested that early ERCP and ductal stenting may lead to resolution of symptoms and healing of the injured duct in selected cases (30-100%), even for grade III injuries, thus avoiding major laparotomy and resection. 10 Notably, data are based on case series with variable outcome, but endoscopic management has gained both popularity and success, even for main duct disruptions.…”

Stumpe pancreasskader hos barn

“…Sequelae following ERCP may occur, e.g. strictures in the pancreatic duct, pancreatic fistula and fluid collection requiring drainage, and subsequent development of pseudocysts (20,35). There are no relevant studies on whether somatostatin analogues (such as sandostatin) have a role in conservative treatment to reduce pancreatic secretions.…”

“…This examination is the last resort for strictly diagnostic purposes, but it is indicated if injury to the pancreatic duct is suspected but cannot be confirmed using another modality. The method also plays a role in the treatment of pancreatic duct injury (9,35,36).…”

“…ERCP involving insertion of a stent is regarded as a non-surgical treatment method (9,20,28,35,36), although this is an intervention which, among other things, is associated with an increased risk of pancreatitis. Stent treatment may reduce leakage of pancreatic secretions into the pancreatic cavity (in cases of pseudocyst or pancreatic fistula).…”