Endoscopic Therapy for Pancreatic Duct Leaks and Disruptions

Varadarajulu, Shyam; Rana, Surinder Singh; Bhasin, Deepak K.

doi:10.1016/j.giec.2013.06.008

Cited by 114 publications

(118 citation statements)

References 103 publications

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“…This is in contrast to walled off necrosis, where it is best to use a purpose designed, wall-opposing, selfexpanding metal stent that also permits endoscopic debridement [37]. Rarely, it is possible to successfully treat a pseudocyst by the placement of a transampullary drain directly into the pseudocyst cavity after first defining a communication between the main pancreatic duct and the pseudocyst cavity by endoscopic retrograde pancreatography [38].…”

Section: Surgical Treatment Of Pseudocystmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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Section: Surgical Treatment Of Pseudocystmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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“…The leakage of pancreatic juice from the disruption can lead to local complications like acute pancreatic fluid collection, walled off necrosis or pancreatic pseudocysts, pancreatic pleural effusion or ascites. 1 Use of percutaneous drainage catheters to drain infected or symptomatic fluid collections may convert an internal pancreatic fistula into an external pancreatic fisula.…”

Section: Discussionmentioning

confidence: 99%

“…1 The outcome is good when transpapillary insertion of endoprosthesis is able to completely bridge the disruption of the pancreatic duct. 2 However, when bridging of disruption is not achieved the EPFs are difficult to treat.…”

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confidence: 99%

Successful treatment of refractory external pancreatic fistula by transpapillary stent insertion into the fistula tract (endoscopic fistuloduodenostomy)

Rana¹

2017

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“…El pseudoquiste pancreático es una complicación local debido a la ruptura del conducto pancreático en pancreatitis aguda o crónica, trauma u obstrucción del conducto pancreático. Este daño del conducto conlleva a la acumulación del jugo pancreá-tico, el cual es encerrado por una pared no epitelizada en un período de 4 a 6 semanas y se forma el pseudoquiste (2).…”

Section: Introductionunclassified

“…Tradicionalmente, el manejo quirúrgico era el tratamiento de elección, pero por el desarrollo de las técnicas endoscópicas en los últimos años el manejo ha evolucionado a abordajes mínimamente invasivos (8). Los pseudoquistes pancreáticos pueden ser drenados endoscó-picamente por un abordaje transpapilar o transmural según esté comunicado con el conducto pancreático principal, y algunas veces puede ser necesaria la combinación de ambos métodos (2,8). El drenaje transmural se logra insertando un stent entre el pseudoquiste pancreático y la luz gástrica (cistogastrostomía) o duodenal (cistoduodenostomía), se puede realizar por vía endoscópica directa como un procedimiento semiciego si hay un abultamiento gástrico o duodenal producido por el quiste o bajo visión ecoendoscópica con tasas significativamente más altas de éxito (4, 9-11).…”

Section: Introductionunclassified

Drenaje de pseudoquiste pancreático guiado por ecoendoscopia sin fluoroscopia: serie de casos

Zuleta

Mindiola

Morales

2017

Rev. Colomb. Gastroenterol.

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ResumenIntroducción: los pseudoquistes pancreáticos pueden ser drenados por métodos quirúrgicos, laparoscópicos, percutáneos y endoscópicos. Este último es el más aceptado en la actualidad dado que es más simple y genera menos morbimortalidad; sin embargo, siempre se ha descrito asociado con el uso de la fluoroscopia, lo cual le suma complejidad. En este trabajo presentamos nuestra técnica de drenaje sin fluoroscopia guiado por ecoendoscopia. Materiales y métodos: el objetivo de este trabajo es describir una técnica de drenaje de pseudoquistes pancreá-ticos sin el uso de fluoroscopia y con la guía del ecoendoscopio. Se reporta una serie de casos de 10 pacientes a quienes se les realizó drenaje transgástrico, en los que se describen la técnica, complicaciones y resultados en el seguimiento. Resultados: se incluyeron 10 pacientes consecutivos, 5 pacientes eran mujeres y 5 hombres. El 90% de los casos comprometía el cuerpo del páncreas. Se implantó exitosamente 1 stent (metálico) transmural (cistogastrostomía) solo con guía ecoendoscópica en 9 pacientes; en 1 paciente no se logró liberar el stent, por lo cual se realizó el drenaje por aspiración. Los 9 pacientes a quienes se les implantó stent no presentaron recidiva; la paciente a quien se realizó drenaje por aspiración presentó recidiva a nivel del cuerpo de páncreas. La principal complicación fue la migración del stent hacia la cavidad del pseudoquiste en 1 paciente, el cual requirió segundo tiempo endoscópico para retirarlo. Conclusiones: el drenaje transmural del pseudoquiste pancreático con implante de stent es una técnica mínimamente invasiva, segura y efectiva para el tratamiento del pseudoquiste pancreático. Palabras clavePancreatitis, pseudoquiste, ecoendoscopia, drenaje. AbstractIntroduction: Pancreatic pseudocysts can be drained by surgical, laparoscopic, percutaneous, and endoscopic methods. Endoscopic methods have become the most widely accepted nowadays since they are simpler and generate less morbidity and mortality. They have always been associated with the use of fluoroscopy, which adds complexity. This study presents our drainage technique which is guided by echoendoscopy rather than fluoroscopy. Materials and methods: The objective of this study is to describe a technique for drainage of pancreatic pseudocysts which does not use fluoroscopy to guide the endoscope. Instead, echoendoscopy guides the instrument. We report a case series of 10 patients who underwent transgastric drainage and describe the technique, complications and results during follow-up. Results: Ten consecutive patients, five women and five men, were included in this study. Ninety percent were cases in which the body of the pancreas had been compromised. Cystogastrostomy was successfully performed in nine patients. It consisted of implantation of a transmural metallic stent under single endoscopic guidance. In one patient the stent was not released and aspiration drainage was performed. The nine patients who had stents implanted have presented no recurrences, but the patient who...

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Endoscopic Therapy for Pancreatic Duct Leaks and Disruptions

Cited by 114 publications

References 103 publications

Surgery for Acute Pancreatitis

Surgery for Acute Pancreatitis

Successful treatment of refractory external pancreatic fistula by transpapillary stent insertion into the fistula tract (endoscopic fistuloduodenostomy)

Drenaje de pseudoquiste pancreático guiado por ecoendoscopia sin fluoroscopia: serie de casos

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