Endoscopic treatment as first‐line therapy for pancreatic ascites and pleural effusion

Pai, C. Ganesh; Suvarna, Deepak; Bhat, Ganesh

doi:10.1111/j.1440-1746.2009.05796.x

Cited by 64 publications

(45 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These interventions are thought to decrease pancreatic secretions facilitating fistula closure and promote serosal apposition and healing 8. This approach has high failure rates of 40–60%,9 10 mortality rates of 17%1 2 and may be costly 11. Risk factors for failure of conservative therapy include severity of pancreatic duct disease seen on ERCP including the presence of more than one site of contrast extravasation and degree of biochemical abnormalities on admission labs including low serum sodium and serum albumin levels and a higher ratio of ascitic fluid protein to total serum protein levels 10.…”

Section: Discussionmentioning

confidence: 99%

“…These stents facilitate healing of ductal disruptions either by partial obstruction of the main pancreatic duct or bypassing the pancreatic sphincter to reduce intraductal pressure and create preferential flow through the stent 1 6. ERCP has the potential complication of secondary infection of the ascites or pseudocysts and adequate precautions to minimise risk should be taken including limiting volume of contrast used and postprocedure antibiotic prophylaxis 11. A study by Bracher et al 6 describes seven of eight cases that underwent endoscopic placement of a transpapillary pancreatic duct stent with complete resolution of PA within 6 weeks of initial stent placement and no recurrence during a 14-month follow-up period.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting

2014

View full text Add to dashboard Cite

Management of pancreatic ascites poses significant therapeutic challenges. Treatment usually consists of either conservative management or interventional therapy with little consensus between the two options. Conservative therapy is the most common initial treatment option but has high failure rates hence arguing for interventional therapy as a preferred primary treatment option. Endoscopic treatment is particularly appealing due to lower failure rates and mortality than conservative therapy or surgery. We describe a patient with recurrent pancreatic ascites who was successfully managed with endoscopic transpapillary stenting. This report contributes to the limited but growing literature on the management of pancreatic ascites.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting

2014

View full text Add to dashboard Cite

show abstract

“…Complication rates of from 7% to 25% have been reported (14)(15)(16). Nevertheless, it has been suggested that pancreaticopleural fistulas may be best managed by ERCP-guided therapeutic intervention or by early surgical treatment (17).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

et al. 2012

View full text Add to dashboard Cite

A 53-year-old man developed bilateral pleural effusion with respiratory failure. The amylase level in the pleural effusion was elevated. He had neither abdominal symptoms nor abdominal physical findings. Abdominal computed tomography (CT) also showed no abnormalities. Magnetic resonance cholangiopancreatography (MRCP) was non-diagnostic, but endoscopic retrograde cholangiopancreatography (ERCP) and subsequent CT showed a fistula connecting the pancreatic duct with the right pleural cavity. The pleural effusion was refractory to drug therapy, leading to the need for surgical intervention. The pathological findings revealed chronic pancreatitis without pseudocysts. The elevated pancreatic amylase in the pleural effusion offered an important clue to the correct diagnosis.

show abstract

“…Therefore, there is also the report that combined endoscopic and percutaneous rendezvous technique is the efficient method to reduce the pressure in cases of failure of endoscopic stenting 33) . Although stent therapy has been reported to be more invasive and carries a greater risk than medical therapy, it has been reported to be safer than surgical treatment 25,26) .…”

Section: Discussionmentioning

confidence: 99%

“…The previous reports showed that ERCP is the most specific modality for identifying the pancreatic duct anatomy and the site of disruption. The reported advantage of ERCP is that it offers the opportunity for definitive therapy using an endoscopic stent, sphincterotomy, or nasopancreatic drainage 25,26) .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system

Tanaka¹,

Kuroki²,

Kitasato³

et al. 2013

Pancreatology

View full text Add to dashboard Cite

Abstract[Background]Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity.[Method]Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome.[Results]All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct, and three patients improved completely and one patient improved temporarily. Finally, three patients underwent [Conclusion]Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.

show abstract

Endoscopic treatment as first‐line therapy for pancreatic ascites and pleural effusion

Abstract: Endoscopic therapy offers an excellent therapeutic alternative in patients with pancreatic ascites and pleural effusion.

Cited by 64 publications

References 25 publications

Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting

Therapeutic challenges of pancreatic ascites and the role of endoscopic pancreatic stenting

Bilateral Pleural Fluid Caused by a Pancreaticopleural Fistula Requiring Surgical Treatment

Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system

Contact Info

Product

Resources

About