The role of transpapillary drainage in management of patients with pancreatic fluid collections and pancreatic duct disruption as a consequences of severe acute pancreatitis

Jagielski, Mateusz; Smoczyński, Marian; Adrych, Krystian

doi:10.1016/j.pan.2016.11.004

Cited by 3 publications

(6 citation statements)

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“…However the majority (90.48%) of patients suffered from partial disruption of the MPD, which enabled stenting of the disruption using pancreatic endoprosthesis and, consequently, led to better results of endoscopic treatment. Partial disruption of the MPD is associated with better outcomes of endotherapy compared to complete disruption of the MPD ( Devière et al., 1995 ; Varadarajulu et al., 2005 ; Jagielski et al., 2017 ; Jagielski et al, 2018a ; Jagielski and Jackowski, 2021a ). Although endotherapy is a more effective treatment method in cases of partial disruption of the pancreatic duct compared with total disruption in patients with pancreatitis, we believe that stenting of the MPD should also be applied in patients with complete duct disruption ( Jagielski et al., 2018b ; Jagielski et al., 2021a ; Jagielski et al., 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the etiology, disruption of the main pancreatic duct (MPD) or smaller pancreatic ducts, defined as a break in the continuity of the duct leading to leakage of pancreatic juice, is at the root of the development of PF (Larsen and Kozarek, 2014;Jagielski et al, 2018a;Jagielski et al, 2018b). Disruption of MPD occurs in over 80% patients with post-inflammatory pancreatic and peripancreatic fluid collections (PPFCs) during the course of acute or chronic pancreatitis (Tay and Chang, 2013;Jagielski et al, 2017;Jagielski et al, 2020;Jagielski and Jackowski, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic treatment of disruption in the continuity of the MPD, and consequently, PFs caused by pancreatitis, involves performing endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and implantation of the prosthesis into the MPD (passive transpapillary drainage) to ensure physiological outflow of pancreatic juice into the duodenum (Jagielski et al, 2017;Jagielski et al, 2018a;Jagielski et al, 2018b;Jagielski et al, 2020;Jagielski and Jackowski, 2021b) The use of endoscopic techniques in the treatment of MPD disruption caused by pancreatitis remains controversial (Boxhoorn et al, 2021). Most of the evidence on the diagnosis and therapy of post-inflammatory PPFs is derived from single case reports (Wee et al, 2017;Ramahi et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic treatment of pancreaticopleural fistulas

Jagielski

Piątkowski

Jackowski

2022

Front. Cell. Infect. Microbiol.

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IntroductionPancreaticopleural fistula (PPF) is a serious complication of acute and chronic pancreatitis.ObjectiveTo evaluate the effectiveness of various endoscopic techniques for the treatment of patients with PPFs.MethodologyProspective analysis of the results of endoscopic treatment of 22 patients with PPF due to pancreatitis was conducted at the Department of General, Gastroenterological, and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, between 2018 and 2021.ResultsPPF was diagnosed in 22 patients (21 men and 1 woman; mean age 49.52 [30–67] years) with pancreatitis. In 19/22 (86.36%) patients, PPF communicated with the left pleural cavity and in 3/22 (13.64%) patients with the right pleural cavity. Chronic pancreatitis was diagnosed in 14/22 (63.64%) patients. Symptomatic pancreatic fluid collections were found in 15/22 (68.18%) patients with PPF (pancreatic pseudocyst in 11 and walled-off pancreatic necrosis in four patients). Endoscopic retrograde cholangiopancreatography was performed in 21/22 (95.45%) patients, confirming the diagnosis of PPF. All 21 patients underwent endoscopic sphincterotomy with prosthesis implantation in the main pancreatic duct (passive transpapillary drainage). In 1/22 (4.55%) patients, active transmural/transgastric drainage of the PPF was necessary due to inflammatory infiltration of the peripapillary region, precluding endoscopic pancreatography. Endoscopic transmural drainage was performed in all the 15 patients with pancreatic fluid collection. Clinical success was achieved in 21/22 (95.45%) patients. The mean total time of endotherapy was 191 (range 88–712) days. Long-term success of endoscopic treatment of PPFs during one year follow-up period was achieved in 19/22 (86.36%) patients.ConclusionsEndoscopic treatment is effective for managing post-inflammatory PPFs. The preferred treatment method is passive transpapillary drainage (prosthesis of the main pancreatic duct). If transpapillary drainage is not feasible, transmural drainage of the PPF remains the preferred method. Endoscopic transmural drainage leads to closure of the fistula canal in patients with pancreatic fluid collection complicated by PPF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic treatment of pancreaticopleural fistulas

Jagielski

Piątkowski

Jackowski

2022

Front. Cell. Infect. Microbiol.

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“…The presence of infection was presumed based on clinical signs (such as deterioration of general condition or fever) or the presence of extraluminal gas in the pancreatic or peripancreatic tissue on contrast-enhanced computed tomography. PNF samples were obtained during the first step of endoscopic treatment of symptomatic WOPN as described previously [12][13][14]. Infection of WOPN was confirmed by culture of PNF obtained from image-guided fine-needle aspiration in 14 patients.…”

Section: Methodsmentioning

confidence: 99%

High levels of reactive oxygen species in pancreatic necrotic fluid of patients with walled-off pancreatic necrosis

Rojek¹,

Hebanowska²,

Stojek³

et al. 2021

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Introduction: Walled-off pancreatic necrosis (WOPN) is a life-threatening, late complication of acute pancreatitis, in which a fluid collection containing necrotic material is formed. Infection of the fluid collection significantly increases the mortality of patients with WOPN.Aim: To examine the levels of oxidative stress markers in the pancreatic necrotic fluid (PNF) and serum of patients with sterile and infected WOPN.Material and methods: Thirty-three adult patients with sterile WOPN and 14 with infected WOPN, as well as 31 patients with mild AP, were included in this study. Concentrations of oxidative stress markers (8-isoprostane, protein carbonyl groups, and 8-hydroxyguanine) were measured in the PNF and serum of patients with sterile and infected WOPN.Results: High concentrations of all measured oxidative stress markers in PNF, but not in serum, were detected in patients with WOPN. Additionally, oxidative stress markers in PNF were significantly increased in patients with infected as compared to sterile WOPN. The serum high sensitive C-reactive protein (hsCRP) concentrations showed the highest correlation with PNF oxidative stress marker levels. Receiver operating characteristics (ROC) curve analysis confirmed that serum hsCRP could be a good predictor of WOPN infection.Conclusions: Oxidative stress is associated with WOPN development; infection of PNF worsens the course of WOPN, possibly via increased production of reactive oxygen species; and serum hsCRP concentrations seem to be a good, noninvasive indicator of PNF infection.

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Diagnostics of postnecrotic pancreatic cysts (review of literature)

Черданцев

Первова

Noskov

et al. 2020

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The problem of diagnosing postnecrotic cysts of the pancreas is considered in this article. The characteristics of laboratory (determination of the level of amylase, cytological research of punctate, determination of tumor markers) and radiation (ultrasound, endosonography, RCP, MSCT, etc.) methods of research of this pathology are presented, their specificity in the differential diagnosis of cystic formations, depressurization of the main pancreatic duct and formation of the cyst wall is considered. We concluded that the use of radiation methods of research significantly improves the diagnosis of pseudocyst of the pancreas and allows to choose a rational treatment tactics and an adequate surgical intervention.

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The role of transpapillary drainage in management of patients with pancreatic fluid collections and pancreatic duct disruption as a consequences of severe acute pancreatitis

Cited by 3 publications

References 6 publications

Endoscopic treatment of pancreaticopleural fistulas

Endoscopic treatment of pancreaticopleural fistulas

High levels of reactive oxygen species in pancreatic necrotic fluid of patients with walled-off pancreatic necrosis

Diagnostics of postnecrotic pancreatic cysts (review of literature)

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