[Endoscopic pancreatic stenting in pancreatic fistulas management]

[Modern endoscopic technologies for chronic calcifying pancreatitis]

OBJECTIVE

To evaluate the effectiveness and safety of electrohydraulic lithotripsy of calculi of the main pancreatic duct using ultrathin SpyGlass DS endoscope.

MATERIAL AND METHODS

The study included 29 patients with chronic calcifying pancreatitis and obstructive calculi of the main pancreatic duct. All surgeries were carried out between 2018 and 2023.

RESULTS

Complete removal of calculi (≥5 mm) within one procedure was achieved in 25 (86%) patients.

CONCLUSION

Pancreatoscopy with electrohydraulic lithotripsy using the digital SpyGlass DS system (BostonScientificCorp, Marlborough, MA) is the most effective method for calculi of the main pancreatic duct.

[Surgical treatment of chronic pancreatitis: indications, timing, methods]

The review is devoted to complex treatment of chronic pancreatitis considering modern data on pathogenesis of this disease. The authors analyze various aspects of endoscopic and surgical interventions in refractory pain syndrome and complications of chronic pancreatitis, as well as positive and negative aspects of each method. Various surgical interventions and indications are analyzed in detail. One of the important points was analysis of the period between disease onset and surgical treatment that affects quality of life in patients with chronic pancreatitis in mid- and long-term period.

Endoscopic intraluminal treatment of pancreatic fluid collections after pancreas transplantation

OBJECTIVE

To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct.

MATERIAL AND METHODS

There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct.

RESULTS

All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm³. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct.

CONCLUSION

Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.

[Results of 300 pancreatic duct stenting in acute pancreatitis]

OBJECTIVE

To analyze the results of pancreatic duct stenting in moderate and severe forms of pancreatitis.

MATERIAL AND METHODS

Pancreatic duct stenting in 300 patients with acute pancreatitis was analyzed. Examination and treatment were carried out in accordance with national clinical guidelines for acute pancreatitis (2015).

RESULTS

Pancreatic duct stenting was performed in 300 patients with moderate and severe forms of pancreatitis (according to APACHE II) in the first 8-72 hours after the onset of the disease. Plastic stent sizes range from 4 to 7 cm in length and 5 to 7 Fr in diameter. Infection with pancreonecrosis occurred in 22 (7.3%) of 300 patients in the main group, and 20% of 150 patients in the control group. Mortality was 16 (5.3%) in the main group, and 24 (16%) - in the control group.

CONCLUSIONS

Pancreatic stenting reduced infection by 3, 2 times, and mortality by 4 times. The dosage of Octreotide was personalized depending on the severity of the disease according to APACHE II.

[Complex treatment of patient with chronic pancreatitis]

Chronic pancreatitis complicated by pancreatic duct stones and pancreatic hypertension, post-necrotic cysts and fistulas requires surgical treatment. There are various procedures from minimally invasive to advanced pancreatectomy. Endoscopic interventions and radical open surgery allow to achieve good results. Successful complex treatment of patient with chronic pancreatitis is presented in this report.