1
|
Sánchez-Muñoz MP, Camba-Gutiérrez SI, Aguilar-Espinosa F. Pancreatic Pseudocyst and Obesity: Video Case Report of Management with the One-Stage Procedure. Obes Surg 2024:10.1007/s11695-024-07335-w. [PMID: 38888708 DOI: 10.1007/s11695-024-07335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
Reports of pancreatic pseudocyst drainage during metabolic bariatric surgery are extremely rare. Our patient is a 38-year-old female suffering from obesity grade IV and presents a persistent symptomatic pancreatic pseudocyst 8 months after an episode of acute biliary pancreatitis. After an extensive evaluation and considering other treatment options, our multidisciplinary team and the patient decided to perform a one-stage procedure consisting of laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass. After bringing the patient to the operating room, the surgeon performed an anterior gastrostomy to access the stomach's posterior wall, followed by a 6-cm cystogastrostomy on both the stomach's posterior wall and the cyst. Next, a cholecystectomy which involved dissecting the triangle of Calot was performed. Then, an 18-cm gastric pouch using a 36-Fr calibration tube was created. The cystogastrostomy was left in the remaining stomach. Finally, gastrojejunal anastomosis is done. The patient's postoperative course proceeded smoothly, leading to her home discharge on the third postoperative day. At the 1-year follow-up, the patient had lost 56 kg and was symptom-free; a computer tomography scan showed that the pancreatic pseudocyst had resolved. This case shows a video of a successful laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass (OAGB) used to treat persistent abdominal pain and obesity grade IV. We also conduct a bibliographic review.
Collapse
Affiliation(s)
- Martha Patricia Sánchez-Muñoz
- Department of Bariatric and Metabolic Surgery of the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Susana Ileana Camba-Gutiérrez
- Department of Bariatric and Metabolic Surgery of the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico
| | - Francisco Aguilar-Espinosa
- Obesity Surgery Clinic: Dr. Francisco Aguilar-Espinosa, Department of General Surgery of the General Hospital of Zone 21, Mexican Institute of Social Security, Morelos 426, 47600, Tepatitlan, Jalisco, Mexico.
| |
Collapse
|
2
|
Sameera S, Mohammad T, Liao K, Shahid H, Sarkar A, Tyberg A, Kahaleh M. Management of Pancreatic Fluid Collections: An Evidence-based Approach. J Clin Gastroenterol 2023; 57:346-361. [PMID: 36040932 DOI: 10.1097/mcg.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Managing pancreatic fluid collections (PFCs) remains a challenge for many clinicians. Recently, significant progress has been made in the therapy of PFCs, including improvements in technology and devices, as well as in the development of minimally invasive endoscopic techniques, many of which are proven less traumatic when compared with surgical options and more efficacious when compared with percutaneous techniques. This review will explore latest developments in the management of PFCs and how they incorporate into the current treatment algorithm.
Collapse
Affiliation(s)
- Sohini Sameera
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | |
Collapse
|
3
|
Ortizo RD, Jalali F, Thieu D, Yu A, Bucayu R, Paiji C, Fortinsky K, Chang K, Lee JG, Samarasena JB. Single-center experience demonstrating low adverse events and high efficacy with self-expandable metal esophageal and biliary stents for pseudocyst and walled off necrosis drainage. Endosc Int Open 2020; 8:E1156-E1160. [PMID: 32904832 PMCID: PMC7458734 DOI: 10.1055/a-1178-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background and study aims Lumen-apposing metal stents (LAMS) have been designed as proprietary stents for the management of pseudocysts (PC)/walled off necrosis (WON). There has been concern about adverse events (AEs) with LAMS including bleeding, buried stent syndrome and migration. Prior to LAMS becoming available, fully-covered self-expandable metal esophageal and biliary stents (FCSEMSs) were used off-label for management of PC/WON with many centers demonstrating low rates of AEs. The primary aim of this study was to study the safety and efficacy of FCSEMS for the management of pseudocysts/WON. Patients and methods This was a retrospective review of all endoscopic ultrasound (EUS)-guided placement of FCSEMSs for drainage of PC/WON cases performed at our institution over 4-year period. The primary outcomes studied were technical success, AEs, PC/WON resolution, and salvage surgical/radiologic intervention. Results Technical success achieved in 65 of 65 (100 %) study patients. An AE occurred 0 of 25 patients (0 %) with PC, and in 10 of 40 patients (25 %) with WON: bleeding (3 %), migration (5 %) and stent dysfunction/infection (18 %). There was resolution in 25 of 25 patients (100 %) with a PC and 31 of 40 patients (78 %) with a WON. Salvage therapy by interventional radiology or surgery was performed in nine of 40 patients (22 %). Conclusions This single-center 4-year experience in the pre-LAMS era showed that FCSEMS was safe and effective in all patients with PC and over 75 % of patients with WON. Given the large cost differential between LAMS and FCSEMS and the efficacy and safety shown with FCSEMS, we believe that FCSEMS should still be considered a first-line option for patients with pancreatic fluid collections, particularly in patients with PCs.
Collapse
Affiliation(s)
- Ronald Dungca Ortizo
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Farid Jalali
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Daniel Thieu
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Allen Yu
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Robert Bucayu
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Christopher Paiji
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Kyle Fortinsky
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Kenneth Chang
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - John Gunn Lee
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| | - Jason Buddika Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States
| |
Collapse
|
4
|
Abstract
Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.
Collapse
|
5
|
Xu MM, Andalib I, Novikov A, Dawod E, Gabr M, Gaidhane M, Tyberg A, Kahaleh M. Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm. Clin Endosc 2019; 53:355-360. [PMID: 31794655 PMCID: PMC7280836 DOI: 10.5946/ce.2019.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety. METHODS Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. RESULTS A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069). CONCLUSION A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.
Collapse
Affiliation(s)
- Ming Ming Xu
- Division of Gastroenterology, Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Iman Andalib
- Division of Gastroenterology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aleksey Novikov
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Enad Dawod
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Moamen Gabr
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Monica Gaidhane
- Division of Gastroenterology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amy Tyberg
- Division of Gastroenterology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| |
Collapse
|
6
|
Medina-Donoso G, Espinosa-Calderón P, Gonzalez-Pardo S, Báez-Morales W. Laparoscopic cystogastrostomy as a treatment for pancreatic pseudocyst: a case report. BIONATURA 2019. [DOI: 10.21931/rb/2019.04.04.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The pancreatic pseudocyst is one of the late local complications of acute pancreatitis, for the management of this entity, there are multiple strategies that range from expectant management, minimally invasive therapy and surgical resolution. Since surgery is the definitive treatment, the laparoscopic approach takes force as a strategy in selected patients. A 47-year-old female patient with multiple comorbidities with pancreatitis of bile origin with subsequent development of pancreatic pseudocyst in whom surgical resolution with a laparoscopic approach is decided. Discussion: The laparoscopic approach shows favorable results; with a procedure duration of 170 minutes on average; the open technique shows several complications: pancreatic fistulas in 40%, enteric fistulas of 20%, incisional hernia of 25%, and mortality of 9 to 25%; Laparoscopic gastrocystostomy allows a much wider communication between the cyst and stomach compared to the endoscopic approach, safe hemostasis and better management of complications. Surgery for the treatment of pseudocyst continues to be the cornerstone; The laparoscopic approach shows the advantages of laparoscopy, with lower morbidity rates compared to open procedures.
Collapse
Affiliation(s)
- Gabriel Medina-Donoso
- Médico Cirujano, Servicio de Cirugía General Hospital IESS-Ibarra. Docente Universidad Católica del Ecuador-Facultad de Medicina. Ecuador
| | - Paúl Espinosa-Calderón
- Médico Anestesiólogo, Servicio de Anestesiología Hospital IESS-Ibarra. Docente Universidad Técnica del Norte - Facultad Ciencias de la Salud. Ecuador
| | - Secundino Gonzalez-Pardo
- Médico Anestesiólogo. Docente Investigador Universidad Técnica del Norte - Facultad Ciencias de la Salud. Ecuador
| | - Widmark Báez-Morales
- Médico Magíster en Gerencia de Salud y Desarrollo Local. Docente Investigador Universidad Técnica del Norte - Facultad Ciencias de la Salud. Ecuador
| |
Collapse
|
7
|
Saluja SS, Srivastava S, Govind SH, Dahale A, Sharma BC, Mishra PK. Endoscopic cystogastrostomy versus surgical cystogastrostomy in the management of acute pancreatic pseudocysts. J Minim Access Surg 2019; 16:126-131. [PMID: 30777987 PMCID: PMC7176009 DOI: 10.4103/jmas.jmas_109_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Studies comparing surgical versus endoscopic drainage of pseudocyst customarily include patients with both acute and chronic pseudocysts and the endoscopic modalities used for drainage are protean. We compared the outcomes following endoscopic cystogastrostomy (ECG) and surgical cystogastrostomy (SCG) in patients with acute pseudocyst. Methods: Seventy-three patients with acute pseudocyst requiring drainage from 2011 to 2014 were analysed (18 patients excluded: transpapillary drainage n = 15; cystojejunostomy n = 3). The remaining 55 patients were divided into two groups, ECG n = 35 and SCG n = 20, and their outcomes (technical success, successful drainage, complication rate and hospital stay) were compared. Results: The technical success (31/35 [89%] vs. 20/20 [100%] P = 0.28), complication rate (10/35 [28.6%] vs. 2/20 [10%]; P = 0.17) and median hospital stay (6.5 days [range 2–12] vs. 5 days [range 3–12]; P = 0.22) were comparable in both the groups, except successful drainage which was higher in surgical group (27/35 [78%] vs. 20/20 [100%] P = 0.04). The conversion rate to surgical procedure was 17%. The location of cyst towards tail of pancreas and presence of necrosis were the main causes of technical failure and failure of successful endoscopic drainage, respectively. Conclusion: Surgical drainage albeit remains the gold standard for management of pseudocyst drainage; endoscopic drainage should be considered a first-line treatment in patients with acute pseudocyst considering the reasonably good success rate.
Collapse
Affiliation(s)
- Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - S Hari Govind
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| |
Collapse
|
8
|
Abstract
Since the original description of pancreatic fluid collections (PFC) in 1761 by Morgagni, their diagnosis, description, and management have continued to evolve. The mainstay of therapy for symptomatic PFCs has been the creation of a communication between a PFC and the stomach, to enable drainage. Surgical creation of these drainage conduits had been the gold standard of therapy; however, there has been a paradigm shift in recent years with an increasing role of endoscopic drainage. The techniques of endoscopic drainage have evolved from blind fluid aspiration to include endoscopic necrosectomy and the placement of lumen-apposing metal stents.
Collapse
Affiliation(s)
- Steven Shamah
- University of Chicago Medical Center, CERT Division, 5700 South Maryland Avenue, MC 8043, Chicago, IL 60637, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Lenox Hill Hospital, 100 East 77th Street, 2nd Floor, New York, NY 10075, USA.
| |
Collapse
|
9
|
Brimhall B, Han S, Tatman PD, Clark TJ, Wani S, Brauer B, Edmundowicz S, Wagh MS, Attwell A, Hammad H, Shah RJ. Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections. Clin Gastroenterol Hepatol 2018; 16:1521-1528. [PMID: 29474970 PMCID: PMC6429551 DOI: 10.1016/j.cgh.2018.02.021] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/26/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPS) in patients with peripancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. METHODS We performed a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 y) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center. We collected data on patient characteristics, outcomes, hospitalizations, and imaging findings. Technical success was defined as LAMS insertion or a minimum of 2 DPS. Clinical success was defined as resolution of pancreatic pseudocysts or walled-off necrosis based on imaging results. The primary outcome was resolution of peripancreatic fluid collection with reduced abdominal pain or obstructive signs or symptoms. Secondary outcomes included the identification and management of adverse events, number of additional procedures required to resolve fluid collection, and the recurrence of fluid collection. RESULTS Patients who received LAMS had larger peripancreatic fluid collections than patients who received DPS prior to intervention (P = .001), and underwent an average 1.7 interventions vs 1.9 interventions for patients who received DPS (P = .93). Technical success was achieved for 90 patients with LAMS (92.8%) vs 137 patients with DPS (90.1%) (odds ratio [OR] for success with DPS, 0.82; 95% CI, 0.33-2.0; P = .67). Despite larger fluid collections in the LAMS group, there was no significant difference in proportions of patients with clinical success following placement of LAMS (82 of 84 patients, 97.6%) vs DPS (118 of 122 patients, 96.7%) (OR for clinical success with DPS, 0.73; 95% CI, 0.13-4.0; P = .71). Adverse events developed in 24 patients who received LAMS (24.7%) vs 27 patients who received DPS (17.8%) (OR for an adverse event in a patient receiving a DPS, 0.82; 95% CI, 0.33-2.0; P = .67). However, patients with LAMS had a higher risk of pseudoaneurysm bleeding than patients with DPS (OR, 10.0; 95% CI, 1.19-84.6; P = .009). CONCLUSIONS In a retrospective study of patients undergoing drainage of pancreatic pseudocysts or walled-off necrosis, we found LAMS and DPS to have comparable rates of technical and clinical success and adverse events. Drainage of walled-off necrosis or pancreatic pseudocysts using DPS was associated with fewer bleeding events overall, including pseudoaneurysm bleeding, but bleeding risk with LAMS should be weighed against the trend of higher actionable perforation and infection rates with DPS.
Collapse
Affiliation(s)
- Bryan Brimhall
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samuel Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philip D Tatman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Toshimasa J Clark
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian Brauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven Edmundowicz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mihir S Wagh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Augustin Attwell
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Hazem Hammad
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| |
Collapse
|
10
|
Abstract
Acute pancreatitis represents a disorder characterized by acute necroinflammatory changes of the pancreas and is histologically characterized by acinar cell destruction. Diagnosed clinically with the Revised Atlanta Criteria, and with alcohol and cholelithiasis/choledocholithiasis as the two most prominent antecedents, acute pancreatitis ranks first amongst gastrointestinal diagnoses requiring admission and 21st amongst all diagnoses requiring hospitalization with estimated costs approximating 2.6 billion dollars annually. Complications arising from acute pancreatitis follow a progression from pancreatic/peripancreatic fluid collections to pseudocysts and from pancreatic/peripancreatic necrosis to walled-off necrosis that typically occur over the course of a 4-week interval. Treatment relies heavily on fluid resuscitation and nutrition with advanced endoscopic techniques and cholecystectomy utilized in the setting of gallstone pancreatitis. When necessity dictates a drainage procedure (persistent abdominal pain, gastric or duodenal outlet obstruction, biliary obstruction, and infection), an endoscopic ultrasound with advanced endoscopic techniques and technology rather than surgical intervention is increasingly being utilized to manage symptomatic pseudocysts and walled-off pancreatic necrosis by performing a cystogastrostomy.
Collapse
|
11
|
Abstract
The last decade has seen dramatic shift in paradigm in the management of pancreatic fluid collections with the rise of endoscopic therapy over radiologic or surgical management. Endosonographic drainage is now considered the gold standard therapy for pancreatic pseudocyst. Infected pancreatic necroses are being offered endoscopic necrosectomy that has been facilitated by the arrival on the market of large diameter lumen-apposing metal stent. Severe pancreatitis or failure to thrive should receive enteral nutrition while pancreatic ductal disruption or strictures are best treated by pancreatic stenting.
Collapse
Affiliation(s)
- Iman Andalib
- Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY
| | | | | |
Collapse
|
12
|
Redwan AA, Hamad MA, Omar MA. Pancreatic Pseudocyst Dilemma: Cumulative Multicenter Experience in Management Using Endoscopy, Laparoscopy, and Open Surgery. J Laparoendosc Adv Surg Tech A 2017; 27:1022-1030. [PMID: 28459653 DOI: 10.1089/lap.2017.0006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pancreatic pseudocyst (PP) is the commonest cystic lesion of the pancreas. Internal drainage of PPs can be accomplished by traditional open or recently by minimally invasive laparoscopic or endoscopic approaches. We aimed to evaluate and compare the clinical outcomes after endoscopic, laparoscopic, and open drainage. METHODS Seventy-one patients with PP underwent endoscopic (n = 35), laparoscopic (n = 4), and open surgical drainage (n = 32). The primary outcome was the success rate. The secondary outcomes were the estimated blood loss, operative time, opioid requirement, morbidity and mortality, length of hospital stay, and recurrence rate. RESULTS The primary success rate was significantly higher for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups. There were no significant differences in the morbidity, mortality, requirement of blood transfusion, reinterventions, and recurrence rate between the groups. Endoscopic drainage revealed significantly lower blood loss, operative time, opioid requirement, and hospital stay in comparison to open and laparoscopic drainage. CONCLUSION Minimally invasive therapeutic techniques, whether endoscopic or laparoscopic for treatment of PP could be considered valuable, competitive, and promising alternatives for open surgery. Moreover, it is less invasive with less hospitalization and rapid return to work.
Collapse
Affiliation(s)
- Alaa A Redwan
- 1 Department of General Surgery, Sohag University , Sohag, Egypt
| | - Mostafa A Hamad
- 2 Department of General Surgery, Assiut University , Assiut, Egypt
| | - Mohammed A Omar
- 3 Department of General Surgery, Qena Faculty of Medicine, South Valley University , Qena, Egypt
| |
Collapse
|
13
|
Bank JS, Adler DG. Lumen apposing metal stents: A review of current uses and outcomes. GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jeffrey S. Bank
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
14
|
Nassour I, Ramzan Z, Kukreja S. Robotic cystogastrostomy and debridement of walled-off pancreatic necrosis. J Robot Surg 2016; 10:279-82. [PMID: 27039191 DOI: 10.1007/s11701-016-0581-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/19/2016] [Indexed: 02/06/2023]
Abstract
Walled-off pancreatic necrosis is a known complication of acute pancreatitis and requires intervention if symptomatic or complicated. Laparoscopic cystogastrostomy as a minimally invasive surgical intervention has been well-described in surgical literature but data on a robotic approach is limited. Here we report a case of robotic cystogastrostomy and debridement of walled-off pancreatic necrosis in a patient with a history of severe biliary pancreatitis.
Collapse
Affiliation(s)
- Ibrahim Nassour
- Departement of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Zeeshan Ramzan
- Departement of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Sachin Kukreja
- Departement of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| |
Collapse
|
15
|
Ge PS, Weizmann M, Watson RR. Pancreatic Pseudocysts: Advances in Endoscopic Management. Gastroenterol Clin North Am 2016; 45:9-27. [PMID: 26895678 DOI: 10.1016/j.gtc.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Endoscopic drainage is the first-line therapy in the management of pancreatic pseudocysts. Before endoscopic drainage, clinicians should exclude the presence of pancreatic cystic neoplasms and avoid drainage of immature peripancreatic fluid collections or pseudoaneurysms. The indication for endoscopic drainage is not dependent on absolute cyst size alone, but on the presence of attributable signs or symptoms. Endoscopic management should be performed as part of a multidisciplinary approach in close cooperation with surgeons and interventional radiologists. Drainage may be performed either via a transpapillary approach or a transmural approach; additionally, endoscopic necrosectomy may be performed for patients with walled-off necrosis.
Collapse
Affiliation(s)
- Phillip S Ge
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 330-33, Los Angeles, CA 90095, USA
| | - Mikhayla Weizmann
- Department of Health Sciences, University of Missouri, 510 Lewis Hall, Columbia, MO 65211, USA
| | - Rabindra R Watson
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 330-33, Los Angeles, CA 90095, USA.
| |
Collapse
|
16
|
Keane MG, Sze SF, Cieplik N, Murray S, Johnson GJ, Webster GJ, Thorburn D, Pereira SP. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2015; 30:3730-40. [PMID: 26675934 PMCID: PMC4992018 DOI: 10.1007/s00464-015-4668-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/14/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs. METHODS Between January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases. RESULTS In total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths. CONCLUSION Compared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.
Collapse
Affiliation(s)
- Margaret G Keane
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
| | - Shun Fung Sze
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Natascha Cieplik
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Sam Murray
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BG, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, Royal Free Hospital, University College London, Pond St, London, NW3 2PF, UK.
| |
Collapse
|
17
|
Marino KA, Hendrick LE, Behrman SW. Surgical management of complicated pancreatic pseudocysts after acute pancreatitis. Am J Surg 2015; 211:109-14. [PMID: 26507289 DOI: 10.1016/j.amjsurg.2015.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/08/2015] [Accepted: 07/25/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Management of pancreatic pseudocysts (PP) is unclear when located in areas outside the lesser sac, infected, or when portal venous (PV) occlusion is present. METHODS Patients having internal drainage of PP. Management and outcome were assessed relative to location, presence of infection, and/or PV occlusion. RESULTS No patient required transfusion, and there were no readmissions in 9 patients with PV occlusion. Eleven patients had infected PP including 5 extending outside the lesser sac. Six had postoperative imaging, 4 readmission, and 3 required adjunct postoperative percutaneous drainage. All but 2 with PP beyond the lesser sac had Roux-en-Y cystjejunostomy including 4 with 2 anastomoses. Nine, 4, and 5 required reimaging, readmission, and postoperative therapeutic intervention, respectively. CONCLUSIONS (1) Open PP drainage in the face of PV occlusion confers a low risk of bleeding and a minimal need for reimaging or readmission; (2) internal drainage of infected PP is a viable option to external drainage; and (3) PP extending beyond the lesser sac can most often be managed successfully by Roux-en-Y drainage but may require additional intervention.
Collapse
Affiliation(s)
- Katy A Marino
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA
| | - Leah E Hendrick
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA
| | - Stephen W Behrman
- Department of Surgery, University of Tennessee Health Science Center & Baptist Memorial Hospital, 910 Madison Avenue, Suite 203, Memphis, TN, 38163, USA.
| |
Collapse
|
18
|
Pezzilli R, Zerbi A, Campra D, Capurso G, Golfieri R, Arcidiacono PG, Billi P, Butturini G, Calculli L, Cannizzaro R, Carrara S, Crippa S, De Gaudio R, De Rai P, Frulloni L, Mazza E, Mutignani M, Pagano N, Rabitti P, Balzano G. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis 2015; 47:532-43. [PMID: 25921277 DOI: 10.1016/j.dld.2015.03.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Abstract
This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
Collapse
|
19
|
Halawani HM, Alami RS, Abi Saad GS. Laparoscopic cyst-gastrostomy after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2015; 11:975-7. [PMID: 26003895 DOI: 10.1016/j.soard.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hamzeh M Halawani
- Department of General Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Ramzi S Alami
- Department of General Surgery, American University of Beirut Medical Centre, Beirut, Lebanon.
| | - George S Abi Saad
- Department of General Surgery, American University of Beirut Medical Centre, Beirut, Lebanon
| |
Collapse
|
20
|
Nitsche U, Siveke J, Friess H, Kleeff J. [Delayed complications after pancreatic surgery: Pancreatic insufficiency, malabsorption syndrome, pancreoprivic diabetes mellitus and pseudocysts]. Chirurg 2015; 86:533-9. [PMID: 25997699 DOI: 10.1007/s00104-015-0006-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Benign and malignant pathologies of the pancreas can result in a relevant chronic disease burden. This is aggravated by morbidities resulting from surgical resections as well as from progression of the underlying condition. OBJECTIVE The aim was to summarize the current evidence regarding epidemiology, pathophysiology, diagnosis and treatment of endocrine and exocrine pancreatic insufficiency, as well as of pancreatic pseudocysts. MATERIAL AND METHODS A selective literature search was performed and a summary of the currently available data on the surgical sequelae after pancreatic resection is given. RESULTS Reduction of healthy pancreatic parenchyma down to 10-15 % leads to exocrine insufficiency with malabsorption and gastrointestinal complaints. Orally substituted pancreatic enzymes are the therapy of choice. Loss of pancreatic islets and/or islet function leads to endocrine insufficiency and pancreoprivic diabetes mellitus. Inflammatory, traumatic and iatrogenic injuries of the pancreas can lead to pancreatic pseudocysts, which require endoscopic, interventional or surgical drainage if symptomatic. Finally, pancreatic surgery harbors the long-term risk of gastrointestinal anastomotic ulcers, bile duct stenosis, portal vein thrombosis and chronic pain syndrome. CONCLUSION As the evidence is limited, an interdisciplinary and individually tailored approach for delayed pancreatic morbidity is recommended.
Collapse
Affiliation(s)
- U Nitsche
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | | | | | | |
Collapse
|
21
|
Slater BJ, Pimpalwar A. Laparoscopic gastroscopic transgastric cystogastrostomy and cholecystectomy for pseudopancreatic cyst after gallstone pancreatitis in children. European J Pediatr Surg Rep 2015; 2:10-2. [PMID: 25755959 PMCID: PMC4335947 DOI: 10.1055/s-0033-1357503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/26/2013] [Indexed: 01/03/2023] Open
Abstract
A 15-year-old girl presented with gallstone pancreatitis. Subsequently, a pseudopancreatic cyst developed that was diagnosed on computed tomographic scan. She underwent a laparoscopic and gastroscopic transgastric cystogastrostomy. In the following report, we describe our novel approach and technique for the above condition.
Collapse
Affiliation(s)
- Bethany J Slater
- Division of Pediatric Surgery, Michael E Debakey Department of General Surgery, Baylor College of Medicine and Texas Children Hospital, Houston, Texas, United States
| | - Ashwin Pimpalwar
- Division of Pediatric Surgery, Michael E Debakey Department of General Surgery, Baylor College of Medicine and Texas Children Hospital, Houston, Texas, United States
| |
Collapse
|
22
|
Pediatric laparoscopic transgastric cystgastrostomy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
23
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the diagnosis and treatment of pancreatic disorders using endoscopy. RECENT FINDINGS The role of endoscopy in the diagnosis and management of pancreatic disorders continues to increase in importance. The use of post-endoscopic retrograde cholangio-pancreatography (ERCP) provides therapy for many pancreatic disorders, including in the treatment of pancreatitis, its complications and pancreatic neoplasia. In recent years, there has been a focus on improving its safety in the prevention of post-ERCP pancreatitis. Pancreatic endotherapy by ERCP for the treatment of biliary strictures and chronic pain in chronic pancreatitis will also be reviewed. Endoscopic ultrasound (EUS) has a vital diagnostic role in pancreatic disorders; however, much of the recent focus has been on its therapeutic role for simple and complex pancreatic fluid collections. As for the role of EUS in pancreatic cancer, recent technical advances in conjunction with on-site cytopathology service continue to improve pancreatic cancer diagnosis. EUS has an increasing role in treatment with fiducial placement for stereotactic body radiation therapy. SUMMARY In this review, I will examine the literature over the last year in ERCP and EUS as they apply to specific pancreatic disorders.
Collapse
|
24
|
Whitehead DA, Gardner TB. Evidence-Based Management of Necrotizing Pancreatitis. ACTA ACUST UNITED AC 2014; 12:322-32. [DOI: 10.1007/s11938-014-0018-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Akshintala VS, Zaheer A, Singh VK. Response. Gastrointest Endosc 2014; 79:1028-9. [PMID: 24856843 DOI: 10.1016/j.gie.2014.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 01/22/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Venkata S Akshintala
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| |
Collapse
|
26
|
Akshintala VS, Saxena P, Zaheer A, Rana U, Hutfless SM, Lennon AM, Canto MI, Kalloo AN, Khashab MA, Singh VK. A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc 2014; 79:921-8; quiz 983.e2, 983.e5. [PMID: 24315454 DOI: 10.1016/j.gie.2013.10.032] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/15/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic drainage (ED) and percutaneous drainage (PD) have largely replaced surgical drainage as the initial approach for symptomatic pseudocysts. However, there are few studies comparing ED and PD. OBJECTIVE To compare the outcomes of ED and PD for symptomatic pseudocysts. DESIGN Retrospective cohort study. SETTING Academic center. PATIENTS Adult patients with symptomatic pseudocysts within ≤ 1 cm of the gastric or duodenal wall who underwent ED or PD between 1993 and 2011. Patients with walled-off pancreatic necrosis were excluded. INTERVENTION ED or PD. MAIN OUTCOME MEASUREMENTS Rates of technical success, procedural adverse events, clinical success, reinterventions, and failure. Other outcomes included the length of hospital stay and number of follow-up abdominal imaging studies. RESULTS There were 81 patients, 41 who underwent ED and 40 who underwent PD, with no differences in age, sex, and comorbidity between the 2 groups. There were no differences in the rates of technical success (90.2% vs 97.5%; P = .36), adverse events (14.6% vs 15%; P = .96), and clinical success (70.7% vs 72.5%; P = .86) between ED and PD, respectively. Patients who underwent PD had higher rates of reintervention (42.5% vs 9.8%; P = .001), longer length of hospital stay (14.8 ± 14.4 vs 6.5 ± 6.7 days; P = .001), and median number [quartiles] of follow-up abdominal imaging studies (6 [3.25, 10] vs 4 [2.5, 6]; P = .02) compared with patients who underwent ED. LIMITATIONS Single center, retrospective study. CONCLUSION ED and PD have similar clinical success rates for symptomatic pseudocysts. However, PD is associated with significantly higher rates of reintervention, longer length of hospital stay, and increased number of follow-up abdominal imaging studies.
Collapse
Affiliation(s)
- Venkata S Akshintala
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Payal Saxena
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Uzma Rana
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Susan M Hutfless
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anne Marie Lennon
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Marcia I Canto
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| |
Collapse
|
27
|
Castoldi L, De Rai P, Zerbi A, Frulloni L, Uomo G, Gabbrielli A, Bassi C, Pezzilli R. Long term outcome of acute pancreatitis in Italy: results of a multicentre study. Dig Liver Dis 2013; 45:827-32. [PMID: 23831129 DOI: 10.1016/j.dld.2013.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/23/2013] [Accepted: 03/02/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. AIM To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. METHODS Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7±8.4 months after discharge. RESULTS The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. CONCLUSION Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness.
Collapse
Affiliation(s)
- Laura Castoldi
- Department of Surgery and Emergency Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145:583-90.e1. [PMID: 23732774 DOI: 10.1053/j.gastro.2013.05.046] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although surgery is the standard technique for drainage of pancreatic pseudocysts, use of endoscopic methods is increasing. We performed a single-center, open-label, randomized trial to compare endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage. METHODS Patients with pancreatic pseudocysts underwent endoscopic (n = 20) or surgical cystogastrostomy (n = 20). The primary end point was pseudocyst recurrence after a 24-month follow-up period. Secondary end points were treatment success or failure, complications, re-interventions, length of hospital stay, physical and mental health scores, and total costs. RESULTS At the end of the follow-up period, none of the patients who received endoscopic therapy had a pseudocyst recurrence, compared with 1 patient treated surgically. There were no differences in treatment successes, complications, or re-interventions between the groups. However, the length of hospital stay was shorter for patients who underwent endoscopic cystogastrostomy (median, 2 days, vs 6 days in the surgery group; P < .001). Although there were no differences in physical component scores and mental health component scores (MCS) between groups at baseline on the Medical Outcomes Study 36-Item Short-Form General Survey questionnaire, longitudinal analysis showed significantly better physical component scores (P = .019) and mental health component scores (P = .025) for the endoscopy treatment group. The total mean cost was lower for patients managed by endoscopy than surgery ($7011 vs $15,052; P = .003). CONCLUSIONS In a randomized trial comparing endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage, none of the patients in the endoscopy group had pseudocyst recurrence during the follow-up period, therefore there is no evidence that surgical cystogastrostomy is superior. However, endoscopic treatment was associated with shorter hospital stays, better physical and mental health of patients, and lower cost. TRIAL REGISTRATION ClinicalTrials.gov: NCT00826501.
Collapse
|
29
|
Saraya T, Light RW, Takizawa H, Goto H. Black pleural effusion. Am J Med 2013; 126:641.e1-6. [PMID: 23591042 DOI: 10.1016/j.amjmed.2012.11.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Black pleural effusions are extremely rare and have been reported in patients with infection, malignancy, and hemorrhage. However, no review articles appear to have focused on this rare clinical presentation. PURPOSE To classify and characterize diseases causing "black pleural effusion" based on the pathophysiological mechanisms involved. METHODS We searched the medical literature to find reports of "black pleural effusion" using the PubMed database. RESULTS We identified 8 cases and classified the underlying diseases into the following 4 entities based on pathophysiological conditions: 1) infection (Aspergillus niger and Rhizopus oryzae); 2) malignant melanoma, in which cells contain melanin pigment; 3) hemorrhage and hemolysis associated with non-small cell lung cancer or rupture of a pancreatic pseudocyst; and 4) other causes (charcoal-containing empyema). Discrimination between biliopleural fistula and pancreatico-pleural fistula, which also mimicking in color, was easily achieved by focusing on pleural amylase levels, elevation of pleural indirect bilirubin, presence of pleural glycoholic acid, and the predominant site of pleural effusion. CONCLUSION Black pleural effusions can be divided into 4 major categories based on the underlying pathophysiological conditions.
Collapse
Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.
| | | | | | | |
Collapse
|
30
|
Patel AD, Lytle NW, Sarmiento JM. Laparoscopic Roux-en-Y Drainage of a Pancreatic Pseudocyst. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0013-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
31
|
|
32
|
Self-expandable metal stents for endoscopic ultrasound-guided drainage of peripancreatic fluid collections. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
Bawany MZ, Rafiq E, Ahmad S, Chaudhry Q, Nawras A. Endoscopic therapy for significant gastric outlet obstruction caused by a small pancreatic pseudocyst with a unique shape and location. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2013; 2:196-198. [PMID: 23687609 DOI: 10.4161/jig.23746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/12/2012] [Accepted: 09/04/2012] [Indexed: 11/19/2022]
Abstract
Large perigastric or periduodenal pseudocysts are a potential cause of gastric outlet obstruction, usually requiring interventional drainage of the pseudocysts. In contrary most of the small pseudocysts are asymptomatic and require no therapy. However, certain small pseudocysts can produce clinically significant problem depending on their location. Here we report a case of small pseudocyst (12.0 mm in width) with a unique shape and location causing significant Gastric outlet obstruction treated successfully with endoscopy.
Collapse
Affiliation(s)
- Muhammad Z Bawany
- Department of Internal Medicine, University of Toledo Medical Center Toledo Ohio
| | | | | | | | | |
Collapse
|
34
|
Murphy AJ, Rauth TP, Lovvorn HN. Chronic biloma after right hepatectomy for stage IV hepatoblastoma managed with Roux-en-Y biliary cystenterostomy. J Pediatr Surg 2012; 47:e5-9. [PMID: 23164033 PMCID: PMC3505688 DOI: 10.1016/j.jpedsurg.2012.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 01/12/2023]
Abstract
We report the complex case of a 12-month-old girl with stage IV hepatoblastoma accompanied by thrombosis and cavernous transformation of the portal vein. After neoadjuvant chemotherapy, she underwent right hepatectomy, which was complicated by iatrogenic injury of her left hepatic duct, and subsequently developed a postoperative biloma and chronic biliocutaneous fistula. Concomitant with multiple percutaneous interventions to manage the biloma nonoperatively while the child completed her adjuvant chemotherapy, she progressed to develop chronic malnutrition, jaundice, and failure to thrive. Once therapy was completed and the child was deemed free of disease, she underwent exploratory laparotomy with Roux-en-Y biliary cystenterostomy for definitive management, resulting in resolution of her biliary fistula, jaundice, and marked improvement in her nutritional status. Roux-en-Y biliary cystenterostomy is a unique and efficacious management option in the highly selected patient population with chronic biliary leak refractory to minimally invasive management.
Collapse
Affiliation(s)
- Andrew J Murphy
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Department of Pediatric Surgery, Nashville, TN 37232-9780, USA.
| | | | | |
Collapse
|
35
|
Cruz-Santamaría DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointest Pathophysiol 2012; 3:60-70. [PMID: 22737590 PMCID: PMC3382704 DOI: 10.4291/wjgp.v3.i3.60] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/22/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce.
Collapse
|
36
|
Mundra V, Zapatier J. An unusual cause of dyspareunia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:93-5. [PMID: 22658550 DOI: 10.1016/j.rgmx.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 12/22/2011] [Accepted: 02/13/2012] [Indexed: 02/04/2023]
Abstract
Pancreatic pseudocyst is a complication of acute pancreatitis and it usually manifests with abdominal pain. We report the case of a 45-year-old man with a history of acute pancreatitis who presented with abdominal pain, dyspareunia, and a palpable inguinal mass. Computed tomography scan revealed a large loculated pseudocyst that dissected through the pelvic cavity towards the inguinal canal, compressing pelvic and inguinal structures. When a patient with a history of pancreatitis develops an inguinal mass, a dissecting pancreatic pseudocyst should be suspected.
Collapse
Affiliation(s)
- V Mundra
- Department of Internal Medicine, Cleveland Clinic Florida, Florida 33331, USA
| | | |
Collapse
|
37
|
Abstract
Techniques of endoscopic pseudocyst management continue to evolve, but the principles of proper patient selection and careful consideration of the available therapeutic options remain unchanged. Endoscopic management is considered first-line therapy in the treatment of symptomatic pseudocysts. Clinicians should be vigilant in the evaluation of all peripancreatic fluid collections to exclude the presence of a pancreatic cystic neoplasm and avoid draining an immature collection. Expectant management with periodic observation should be considered for the minimally symptomatic patients, even after the traditional 6 weeks of maturation. Further, symptoms, complications, and expansion on serial imaging should prompt intervention by endoscopic, surgical, or percutaneous methods. Pseudocysts should only be punctured when the wall has had sufficient time to mature and after pseudoaneurysm has been ruled out by careful imaging. Small to moderately sized pseudocysts (< 4–6 cm) that communicate with the pancreatic duct are good candidates for endoscopic transpapillary stenting. For larger lesions requiring transmural drainage, EUS guidance is preferable, but good results can be achieved with ENL. EUS may be particularly useful in permitting drainage in patients with suspected perigastric varices or if an endoscopically visible bulge is not apparent. Necrosis is a significant factor for a worse outcome; aggressive debridement with nasocystic or percutaneous endoscopic gastrostomy-cystic catheter lavage plus manual endoscopic techniques for clearing debris should be used. Endoscopic failure, especially in cases with significant necrosis, should be managed operatively. Percutaneous drainage is a good option for immature infected pseudocysts or in patients who are not optimal candidates for other procedures. Close cooperation between endoscopists, surgeons, interventional radiologists, and other healthcare providers is paramount in successfully managing these patients.
Collapse
|
38
|
Endoscopic management of peri-pancreatic collections. Gastroenterol Res Pract 2012; 2012:906381. [PMID: 22536223 PMCID: PMC3296159 DOI: 10.1155/2012/906381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/30/2011] [Accepted: 11/07/2011] [Indexed: 01/06/2023] Open
Abstract
Endotherapy of peripancreatic fluid collections is an increasing utilized procedure in interventional endoscopy. The aim of this paper is to provide a general overview of the topic, highlighting the indications, technique, and important management issues relating to endoscopic management of the various forms of peri-pancreatic fluid collections.
Collapse
|
39
|
Rodríguez-D'Jesús A, Fernández-Esparrach G, Saperas E. [Endoscopic treatment of pancreatic pseudocyst. Practical features]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:711-6. [PMID: 22112632 DOI: 10.1016/j.gastrohep.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 11/24/2022]
Abstract
The initial treatment of most cases of pancreatic pseudocyst is endoscopic while surgery has been relegated to patients who cannot undergo this procedure for technical reasons, such as roux-en-Y roux reconstruction, or to those in whom other procedures have been unsuccessful. This change in the management of this entity is due to advances in therapeutic endoscopy (as a result of the development of guidelines, dilatation balloons, prostheses, safer techniques) as well as to better knowledge of the pathogenesis of pancreatic pseudocyst. The present study aims to describe endoscopic procedures for the drainage of pancreatic pseudocysts, particularly key technical features to ensure the maximum safety and effectiveness of this therapeutic technique.
Collapse
|
40
|
Diagnosis and management of cystic lesions of the pancreas. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:478913. [PMID: 21904442 PMCID: PMC3166757 DOI: 10.1155/2011/478913] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 06/29/2011] [Accepted: 06/29/2011] [Indexed: 02/08/2023]
Abstract
Pancreatic cysts are challenging lesions to diagnose and to treat. Determining which of the five most common diagnoses—pancreatic pseudocyst, serous cystic neoplasm (SCN), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal mucinous papillary neoplasm (IPMN)—is likely the correct one requires the careful integration of many historical, radiographic, laboratory, and other factors, and management is markedly different depending on the type of cystic lesion of the pancreas. Pseudocysts are generally distinguishable based on historical, clinical and radiographic characteristics, and among the others, the most important differentiation is between the mucin-producing MCN and IPMN (high risk for cancer) versus the serous SCN and SPN (low risk for cancer). EUS with FNA and cyst-fluid analysis will continue to play an important role in diagnosis. Among mucinous lesions, those that require treatment (resection currently) are any MCN, any MD IPMN, and BD IPMN larger than 3 cm, symptomatic, or with an associated mass, with the understanding that SCN or pseudocysts may be removed inadvertently due to diagnostic inaccuracy, and that a certain proportion of SPN will indeed be malignant at the time of removal. The role of ethanol ablation is under investigation as an alternative to resection in selected patients.
Collapse
|
41
|
Abstract
The advent of computed tomographic scan with its wide use in the evaluation of acute pancreatitis has opened up a new topic in pancreatology i.e. fluid collections. Fluid collections in and around the pancreas occur often in acute pancreatitis and were defined by the Atlanta Symposium on Acute Pancreatitis in 1992. Two decades since the Atlanta Conference additional experience has brought to light the inadequacy and poor understanding of the terms used by different specialists involved in the care of patients with acute pancreatitis when interpreting imaging modalities and the need for a uniformly used classification system. The deficiencies of the Atlanta definitions and advances in medicine have led to a proposed revision of the Atlanta classification promulgated by the Acute Pancreatitis Classification Working Group. The newly used terms "acute peripancreatic fluid collections," "pancreatic pseudocyst," "postnecrotic pancreatic/peripancreatic fluid collections," and "walled-off pancreatic necrosis" are to be clearly understood in the interpretation of imaging studies. The current treatment methods for fluid collections are diverse and depend on accurate interpretations of radiologic tests. Management options include conservative treatment, percutaneous catheter drainage, open and laparoscopic surgery, and endoscopic drainage. The choice of treatment depends on a correct diagnosis of the type of fluid collection. In this study we have attempted to clarify the management and clinical features of different types of fluid collections as they have been initially defined under the 1992 Atlanta Classification and revised by the Working Group's proposed categorization.
Collapse
|
42
|
Rotura esplénica secundaria a seudoquiste de páncreas. Cir Esp 2011; 89:120-2. [DOI: 10.1016/j.ciresp.2010.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 03/12/2010] [Indexed: 11/17/2022]
|
43
|
Imaging of acute pancreatitis: prognostic value of computed tomographic findings. J Comput Assist Tomogr 2010; 34:485-95. [PMID: 20657214 DOI: 10.1097/rct.0b013e3181d344ca] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although most cases of acute pancreatitis are uncomplicated and resolve spontaneously, the presence of complications has significant prognostic importance. Necrosis, hemorrhage, and infection convey up to 25%, 52%, and 80% mortality, respectively. Other complications such as pseudocyst formation, pseudoaneurysm formation, or venous thrombosis increase morbidity and mortality to a lesser degree.We review the computed tomographic findings of complications associated with acute pancreatitis with emphasis on their prognostic significance and impact on clinical management.
Collapse
|
44
|
Boutros C, Somasundar P, Espat NJ. Open cystogastrostomy, retroperitoneal drainage, and G-J enteral tube for complex pancreatitis-associated pseudocyst: 19 patients with no recurrence. J Gastrointest Surg 2010; 14:1298-303. [PMID: 20535579 DOI: 10.1007/s11605-010-1242-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Various techniques have been described to achieve definitive resolution of complex acute pancreatitis associated pseudocysts (PACs). Many of these strategies, inclusive of open, minimally invasive, and radiological procedures, are hampered by high recurrence or failed resolution, particularly for PAC near the pancreatic head. The present series describes a multimodal strategy combining a minilaparotomy for anterior gastrostomy for the creation of a stapled posterior cystogastrostomy, placement of an 8F secured silastic tube for intentional formation of a cystogastric fistula tract in combination with gastric drainage, and postduodenal enteral alimentation. MATERIALS AND METHODS Using a prospectively maintained hepatobiliary database, patients with complex PAC undergoing the above procedures were identified. PAC location, postoperative length of stay (LOS), and time to start enteral feeding were identified. PAC were assessed by computed tomography (CT) scan prior to operation, 1 month after drainage, and patients with PAC resolution were started on oral diet, with the fistula silastic tube kept in place for an additional month. RESULTS Over the interval 2003 to 2008, 19 patients were managed with the stated strategy. PACs were located at the pancreatic body/tail in 12 patients, and 7 patients had PAC at the level of the pancreatic head/neck area. In this cohort, prior to surgical drainage, 17/19 patients had undergone failed endoscopic retrograde cholangiopancreatography (ERCP) with decompressive stent placement and 13/19 had a failed percutaneous PAC drainage. There was no perioperative mortality after open surgical drainage. All patients started on jejunal tube feeding 24 h after surgical procedure. Median postoperative LOS was 7 days (4-13). At 1 month, 16/19 (84%) of patients showed complete resolution of the PAC on CT scan and were started on oral diet; 3/19 required additional month for complete resolution. After a mean follow-up of 31 months, there was no PAC recurrences in any of these patients demonstrated on follow-up. CONCLUSION The described strategy is safe, efficient, and allows early restoration of enteral feeding with early hospital discharge. High resolution rates and absence of PAC recurrences in this series supports this approach for complex PAC.
Collapse
Affiliation(s)
- Cherif Boutros
- Hepatobiliary and Oncologic Surgery, Roger Williams Medical Center, Providence, RI, USA
| | | | | |
Collapse
|
45
|
Abstract
Pseudocyst formation is a well known complication of pancreatitis. Not all pancreatic pseudocysts require intervention. Selected patients who are asymptomatic can be subject to expectant management. Spontaneous resolution has been shown to occur in 40% to 50% of patients with no serious complications occurring during the observation period. Intervention is warranted if the patient is symptomatic, there is a progressive increase in size or if the pseudocyst is infected. Surgery was the only available treatment for pseudocysts for a long time. Of late other modalities like percutaneous, endoscopic, and laparoscopic drainage have come to be seen as viable alternatives.
Collapse
|
46
|
A simple fluoroscopic approach to percutaneous transgastric cystgastrostomy with internalized drainage catheter for treatment of pancreatic pseudocysts: report of two cases. Dig Dis Sci 2010; 55:523-8. [PMID: 19225885 DOI: 10.1007/s10620-009-0722-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 01/12/2009] [Indexed: 12/09/2022]
Abstract
With the emergence of minimally invasive techniques, percutaneous drainage has been applied to the management of symptomatic pancreatic pseudocysts in lieu of conventional surgical or endoscopic therapy. Percutaneous insertion of internalized drainage catheters represents an attractive method for pseudocyst drainage, but has been limited by the usual need for cross-sectional imaging or endoscopic guidance. Herein, we describe the use of a simple fluoroscopically guided technique for percutaneous transgastric cystgastrostomy with internalized drainage catheter placement in two cases.
Collapse
|
47
|
Melman L, Azar R, Beddow K, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Edmundowicz S, Jonnalagadda S, Matthews BD. Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. Surg Endosc 2008; 23:267-71. [PMID: 19037696 DOI: 10.1007/s00464-008-0196-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 08/14/2008] [Accepted: 10/04/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Internal drainage of pancreatic pseudocysts can be accomplished by traditional open or minimally invasive laparoscopic or endoscopic approaches. This study aimed to evaluate the primary and overall success rates and clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts. METHODS Records of 83 patients undergoing laparoscopic (n = 16), endoscopic (n = 45), and open (n = 22) pancreatic cystgastrostomy were analyzed on an intention-to-treat basis. RESULTS There were no significant differences (p < 0.05) in the mean patient age (years), gender, body mass index (BMI) (kg/m(2)), etiology of pancreatitis (% gallstone), or size (cm) of pancreatic pseudocyst between the groups. Grade 2 or greater complications occurred within 30 days of the primary procedure for 31.5% of the laparoscopic patients, 15.6% of the endoscopic patients, and 22.7% of the open patients (nonsignificant differences). The follow-up evaluation for 75 patients (90.4%) was performed at a mean interval of 9.5 months (range, 1-40 months). The primary compared with the overall success rate, defined as cyst resolution, was 51.1% vs. 84.6% for the endoscopic group, 87.5% vs. 93.8% for the laparoscopic group, and 81.2% vs. 90.9% for the open group. The primary success rate was significantly higher (p < 0.01) for laparoscopic and open groups than for the endoscopic group, but the overall success rate was equivalent across the groups (nonsignificant differences). Primary endoscopic failures were salvaged by open pancreatic cystgastrostomy (n = 13), percutaneous drainage (n = 3), and repeat endoscopic drainage (n = 6). CONCLUSIONS Laparoscopic and open pancreatic cystgastrostomy both have a higher primary success rate than endoscopic internal drainage, although repeat endoscopic cystgastrostomy provides overall success for selected patients.
Collapse
Affiliation(s)
- Lora Melman
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO 63110, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Melman L, Matthews BD. Current Trends in Laparoscopic Solid Organ Surgery: Spleen, Adrenal, Pancreas, and Liver. Surg Clin North Am 2008; 88:1033-46, vii. [PMID: 18790153 DOI: 10.1016/j.suc.2008.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
49
|
Jury RP, Tariq N. Minimally invasive and standard surgical therapy for complications of pancreatitis and for benign tumors of the pancreas and duodenal papilla. Med Clin North Am 2008; 92:961-82, x. [PMID: 18570949 DOI: 10.1016/j.mcna.2008.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The treatment of severe pancreatitis and its complications is rapidly evolving because of increasing clinical application of effective, minimally invasive techniques. With ongoing innovations in therapeutic endoscopy, image-guided percutaneous techniques, and minimally invasive surgery, the long-standing traditional management algorithms have recently changed. A multidisciplinary approach is necessary for the treatment of complicated inflammatory diseases of the pancreas and benign periampullary tumors. Surgeons, gastroenterologists, and therapeutic radiologists combine expertise as members of a team to offer their patients improved outcomes and faster recovery.
Collapse
Affiliation(s)
- Robert P Jury
- Division of Gastrointestinal, Pancreatic and Hepatobiliary Surgery, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA.
| | | |
Collapse
|