Enteroscopic Biopsies in the Management of Pancreas Transplants

Abstract

This series of enteroscopies demonstrates that the duodenal segment of a pancreatic graft is accessible using our implant technique, and thus permitting biopsies to be obtained and endoscopic interventions to be performed.

Banff 2013 Meeting Report: Inclusion of C4d-Negative Antibody-Mediated Rejection and Antibody-Associated Arterial Lesions

“…Utilization of biopsies of the grafted duodenal cuff as surrogates for diagnosis of acute pancreas allograft rejection (29): Initial results were presented on prospective analysis of endoscopic biopsies of the duodenal patch, and on retrospective studies of archival tissue.…”

Pancreas Transplantation With Enteroanastomosis to Native Duodenum Poses Technical Challenges—But Offers Improved Endoscopic Access for Scheduled Biopsies and Therapeutic Interventions

“…Transduodenal EUS-guided pancreas biopsies are feasible and seem safe. The procedure is still under evaluation, and the potential diagnostic advantages remain to be conclusively proven (7). The EUS procedure itself did not seem to affect the outcome of the DD-group as few complications to EUS were encountered, and most of the GLs due to thrombosis occurred prior to the first scheduled EUS biopsy.…”

“…No biochemical markers have proven to be effective in rejection surveillance, and the S-PTx procedure has been abandoned in some countries (6). Protocol biopsies of the duodenal segment have previously been performed via double balloon enteroscopy (DBES) of the jejunal anastomosis (7), and percutaneous biopsies of the pancreas graft itself have generally been averted due to fear of biopsy-related complications. Absence of rejection monitoring tools have been compensated with more intensive immunosuppressive regimens in PTx recipients (8).…”

Immunological monitoring after pancreas transplantation

“…Not even one interventionrelated complication was observed. Apart from the fact that this investigation is successful in only twothirds of all cases, the question arises whether biopsies from the graft duodenum are representative for the pancreatic portion [33].…”