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Li W, Wang Q, Cheng C, Gong J. A precise cure for a patient with frequent and severe upper abdominal colic. Asian J Surg 2024:S1015-9584(24)01389-7. [PMID: 38991928 DOI: 10.1016/j.asjsur.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Wei Li
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - Qin Wang
- Department of General Surgery, Chengdu Xinhua Hospital, Chengdu, Sichuan Province, China
| | - ChuanDong Cheng
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - JiaQing Gong
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China.
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Kara S, Ozair S, Brzobohaty M, Nedd K. A Rare Case of Pancreatic Divisum Presentation. Cureus 2023; 15:e37580. [PMID: 37193449 PMCID: PMC10183217 DOI: 10.7759/cureus.37580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Pancreatic divisum (PD) is a malformation wherein the majority of affected patients remain asymptomatic or present with complications early in life. Some cases, however, may present in adulthood with recurrent pancreatitis, which makes the diagnosis clinically challenging. Here, we present a rare case of an elderly female with acute-on-chronic epigastric pain secondary to pancreatitis due to PD. During hospitalization, the patient was treated for acute pancreatitis and subsequently discharged with recommendations for corrective surgery. This case is unique particularly due to the older age of onset of symptoms, as well as the lack of exacerbating factors such as drug abuse, alcohol, or obesity. This case highlights the importance of considering PD as a differential diagnosis when managing patients with recurrent pancreatitis regardless of their age.
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Affiliation(s)
- Sam Kara
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Miami, USA
| | - Saleha Ozair
- Department of Internal Medicine, Larkin Community Hospital, Miami, USA
| | - Miro Brzobohaty
- Department of Internal Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
| | - Kester Nedd
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Miami, USA
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Benign biliary strictures associated with acute biliary pancreatitis. Surg Endosc 2022; 37:2587-2594. [PMID: 36348167 DOI: 10.1007/s00464-022-09753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS There are limited data about the benign biliary strictures (BBS) which can develop during the clinical course of acute biliary pancreatitis (ABP) due to compression of the common bile duct (CBD) by edematous and inflamed pancreatic tissue. We aimed to determine the incidence of BBS due to ABP and its clinical course after endoscopic management. METHODS The study was retrospectively conducted among patients with ABP who were admitted to a single tertiary reference center during 3 years. BBS-ABP was defined as distal narrowing of the CBD with proximal dilatation and delayed drainage of the contrast into the duodenum. Endoscopic treatment was performed by inserting a single 7F or 10F plastic stent which was exchanged every 3 months until stricture resolution. Patients were followed for 1 year after stricture resolution. RESULTS Seven hundred and twenty-one patients had ABP during the study period. Among them, 257 (35.6%) patients underwent ERCP and 26 patients (3.6%) had CBD stricture due to ABP. A 7 Fr plastic stent was inserted in 18 patients and 10 Fr in 8 patients. The stricture was completely resolved at 3 months in 66.7%, at 6 months 23.8% and at 9 months (9.5%) of the patients. There was no procedure-related complications other than asymptomatic stent migration in 4 (19%) patients. None of the patients had recurrent biliary stricture during the 1 year stent-free follow-up period. CONCLUSION BBS-ABP is a frequently seen clinical entity. In most patients, the stricture improves within 3 months and temporary endoscopic stenting prevents the patients from the consequences of the obstruction during this period.
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Somani P, Navaneethan U. Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis. ACTA ACUST UNITED AC 2016; 14:327-39. [PMID: 27371265 DOI: 10.1007/s11938-016-0096-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies including common bile duct stones or sludge, sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), anomalous pancreaticobiliary junction, genetic mutations, and alcohol related. In approximately 30 % of patients, the etiology of RAP is unclear and the term "idiopathic" is used. Endoscopic retrograde cholangiopancreatography (ERCP) can be utilized in both the diagnosis and the initial management of RAP, but it has known limitations and risks. Since gallbladder sludge and SOD account for most cases with RAP, cholecystectomy and, eventually, endoscopic biliary and/or pancreatic sphincterotomy are performed as a part of management. In patients with PD-associated RAP, data from uncontrolled and primarily retrospective studies point toward a benefit from minor papillary endoscopic intervention. However, given the lack of quality data from prospective randomized controlled trials (RCTs), endoscopic management in such patients remains an individualized decision, and RCTs are needed to ascertain its true long-term benefit. Future studies to investigate the role of endoscopic therapy in preventing progression to chronic pancreatitis are needed.
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Affiliation(s)
- Piyush Somani
- Center for Interventional Endoscopy, University of Central Florida College of Medicine, Florida Hospital, 601 E Rollins Street, Orlando, FL, 32803, USA
| | - Udayakumar Navaneethan
- Center for Interventional Endoscopy, University of Central Florida College of Medicine, Florida Hospital, 601 E Rollins Street, Orlando, FL, 32803, USA.
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Gornals JB, Esteban JM, Guarner-Argente C, Marra-Lopez C, Repiso A, Sendino O, Loras C. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined? GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:627-642. [PMID: 26920225 DOI: 10.1016/j.gastrohep.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 02/07/2023]
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders.
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
| | - José Miguel Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clinic San Carlos, Madrid, Spain
| | - Carlos Guarner-Argente
- Endoscopy Unit, Department of Digestive Diseases, Hospital Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Carlos Marra-Lopez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Araba sede Txagorritxu, Alava, Spain
| | - Alejandro Repiso
- Endoscopy Unit, Department of Digestive Diseases, Hospital Virgen de la Salud, Toledo, Spain
| | - Oriol Sendino
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Mútua Terrassa, CIBEREHD, Terrassa, Catalonia, Spain
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Mangiavillano B, Pagano N, Baron TH, Luigiano C. Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review. World J Gastroenterol 2015; 21:9038-9054. [PMID: 26290631 PMCID: PMC4533036 DOI: 10.3748/wjg.v21.i30.9038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/04/2015] [Accepted: 07/08/2015] [Indexed: 02/07/2023] Open
Abstract
Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.
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Kanth R, Samji NS, Inaganti A, Komanapalli SD, Rivera R, Antillon MR, Roy PK. Endotherapy in symptomatic pancreas divisum: a systematic review. Pancreatology 2014; 14:244-50. [PMID: 25062871 DOI: 10.1016/j.pan.2014.05.796] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 12/11/2022]
Abstract
Pancreas divisum (PD) is the most common congenital variant of the pancreas and has been implicated as a cause of pancreatitis; however, endoscopic treatment is controversial. Our objective was to examine patient response to endotherapy for treatment of symptomatic PD in adult patients in a systematic review of the literature. A systematic review of all case series and case-control studies with ten or more patients undergoing endotherapy for treatment of symptomatic PD indicated by acute recurrent pancreatitis (ARP), chronic pancreatitis (CP), or chronic abdominal pain (CAP) was performed. PubMed, Embase, and Web of Science databases were searched from inception through February 2013 using [pancreas divisum] AND [endoscopic retrograde cholangiopancreatography (ERCP)] OR [endotherapy] OR [endoscopy] as search terms. Importantly, the majority of studies were retrospective in nature, significantly limiting analysis capacity. Main outcomes measures included endotherapy response rate in patients with PD and ARP, CP, or CAP. Twenty-two studies were included in the review, with a total of 838 patients. Response to endoscopy was seen in 528 patients, but response rate varied by clinical presentation. Patients with ARP had a response rate ranging from 43% to 100% (median 76%). Reported response rates were lower in the other two groups, ranging from 21% to 80% (median 42%) for patients with CP and 11%-55% (median 33%) for patients with CAP. Complications reported included perforation, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, and clogged stents. Endotherapy appears to offer an effective treatment option for patients with symptomatic PD, with the best results in patients presenting with ARP.
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Affiliation(s)
- Rajan Kanth
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA
| | - N Swetha Samji
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA
| | - Anupama Inaganti
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA
| | | | - Ramon Rivera
- Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA
| | - Mainor R Antillon
- Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA
| | - Praveen K Roy
- Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA; Department of Gastroenterology, Marshfield Clinic, Marshfield, WI, USA.
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Abstract
The use of endoscopic retrograde cholangiopancreatography for treating benign biliary strictures has become the standard of practice, with surgery and percutaneous therapy reserved for selected patients. The gold-standard endoscopic therapy is dilation of the stricture followed by placing and exchanging progressively larger and more numerable plastic stents over a 1-year period. Newer modalities, including the use of fully covered metal stents, are currently under investigation in an effort to improve the treatment of benign biliary strictures.
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