Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections

Trevino, Jessica; Tamhane, Ashutosh; Varadarajulu, Shyam

doi:10.1111/j.1440-1746.2009.06109.x

Cited by 121 publications

(77 citation statements)

References 23 publications

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“…In 563 patients with pseudocysts, they found that spontaneous resolution occurred only in 0%5% of patients with a ductal disruption compared to 87% of patients with a normal pancreatic duct. Similarly, Trevino et al [108] demonstrated improved PFC resolution of both pseudocysts and WOPN in patients who underwent PFC drainage with transpapillary PD stenting compared with PFC drainage alone (97.5% vs 80%). Of note, undergoing ERCP was not associated with any increase in mortality, the need for necrosectomy, or hospital length of stay.…”

Section: Pd Disruption and Pfc Resolutionmentioning

confidence: 84%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

169

154

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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Section: Pd Disruption and Pfc Resolutionmentioning

confidence: 84%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

169

154

View full text Add to dashboard Cite

show abstract

“…19,20 As mentioned above, the use of transpapillary stenting appeared to provide no additional benefit in patients that already received transmural drainage. However, in two studies, it was suggested that if the pancreatic duct stent could bridge the site of leak, treatment success rate was higher.…”

Section: Adjunctive Measures To Pseudocyst Drainagementioning

confidence: 95%

Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

Teoh

Dhir²,

Jin

et al. 2016

Int J Gastrointest Interv

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A B S T R A C TDrainage of pseudocyst and walled-off pancreatic necrosis has traditionally been achieved by surgical means. Recently, there has been a progressive shift in paradigm to performing endoscopic drainage for these conditions. Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic pseudocyst. However, many controversies still exist on the optimal management and wide variations in techniques exist. There is a pressing need for establishment of a consensus for safe practices in EUS-guided pseudocyst drainage.

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“…Complications occurred in 11% of cases, after a mean follow-up of 22 months [29]. In patients with a pancreatic duct disruption that could be bridged, transpapillary pancreatic duct stenting improved outcomes in patients with endoscopic transmural drainage of peripancreatic fluid collections [30]. Trevino et al reviewed 110 patients with endoscopic transmural pancreatic fluid collection drainage (62% pseudocysts), in 40 (36%) patients being added a simultaneous pancreatic duct stenting [30].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with a pancreatic duct disruption that could be bridged, transpapillary pancreatic duct stenting improved outcomes in patients with endoscopic transmural drainage of peripancreatic fluid collections [30]. Trevino et al reviewed 110 patients with endoscopic transmural pancreatic fluid collection drainage (62% pseudocysts), in 40 (36%) patients being added a simultaneous pancreatic duct stenting [30]. Even after multivariable analysis, the patients with a pancreatic duct stenting were significantly more likely to have a treatment success (risk ratio 1.14, 95% confidence interval: 1.01-1.29, p=0.0036).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

Beuran

Negoi

Catena

et al. 2016

JGLD

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Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients’ evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient.

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Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections

Abstract: Transpapillary PD stenting improves treatment outcomes in patients undergoing endoscopic transmural drainage of PFC.

Cited by 121 publications

References 23 publications

Management of pancreatic fluid collections: A comprehensive review of the literature

Management of pancreatic fluid collections: A comprehensive review of the literature

Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

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