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Hocke M, Burmeister S, Braden B, Jenssen C, Arcidiacono PG, Iglesias-Garcia J, Ignee A, Larghi A, Möller K, Rimbas M, Siyu S, Vanella G, Dietrich CF. Controversies in EUS-guided treatment of walled-off necrosis. Endosc Ultrasound 2022; 11:442-457. [PMID: 35313415 PMCID: PMC9921978 DOI: 10.4103/eus-d-21-00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This review gives an overview of different techniques in the treatment of post-acute complications of acute pancreatitis. The endoscopic treatment of those complications is currently standard of care. EUS opened up the broad implementation of internal drainage methods to make them safe and effective. Due to different endoscopic approaches worldwide, controversies have arisen that are pointed out in this paper. The main focus was placed on weighing up evidence to find the optimal approach. However, if no evidence can be provided, the authors, experienced in the field, give their personal advice.
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Affiliation(s)
- Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Sean Burmeister
- Hepato-Pancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg; Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin, Germany
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Spain
| | - André Ignee
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Mihai Rimbas
- Gastroenterology and Internal Medicine Departments, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Sun Siyu
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
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Hao W, Chen Y, Jiang Y, Yang A. Endoscopic Versus Laparoscopic Treatment for Pancreatic Pseudocysts: A Systematic Review and Meta-analysis. Pancreas 2021; 50:788-795. [PMID: 34347721 PMCID: PMC8376268 DOI: 10.1097/mpa.0000000000001863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/21/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the efficacy and safety of endoscopic treatment for pancreatic pseudocysts (PPCs) compared with laparoscopic treatment. METHODS The Embase, Medline, Cochrane Library, Web of Science databases, China National Knowledge Infrastructure Chinese citation database, and WANFANG database were systematically searched to identify all comparative trials investigating endoscopic versus laparoscopic treatment for PPC. The main outcome measures included treatment success rate, adverse events, recurrence rate, operation time, intraoperative blood loss, and hospital stay. RESULTS Six studies with 301 participants were included. The results suggested that there was no difference in rates of treatment success (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.40-2.01; P = 0.79), adverse events (OR, 0.80, 95% CI, 0.38-1.70; P = 0.57), or recurrence (OR, 0.55, 95% CI, 0.22-1.40; P = 0.21) between endoscopic and laparoscopic treatments. However, the endoscopic group exhibited reduced operation time (weighted mean difference [WMD], -67.11; 95% CI, -77.27 to -56.96; P < 0.001), intraoperative blood loss (WMD, -65.23; 95% CI, -103.38 to -27.08; P < 0.001), and hospital stay (WMD, -2.45; 95% CI, -4.74 to -0.16; P = 0.04). CONCLUSIONS Endoscopic treatment might be suitable for PPC patients.
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Affiliation(s)
| | - Yunli Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Aiming Yang
- From the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Liu Y, Wang D, Hao L, Wang T, Zhang D, Yang HY, Ma JY, Li J, Zhang LL, Lin K, Chen C, Guo HL, Bi YW, Xin L, Zeng XP, Chen H, Xie T, Liao Z, Cong ZJ, Li ZS, Hu LH. Risk Factors Analysis and Nomogram Development for Pancreatic Pseudocyst in Idiopathic Chronic Pancreatitis. Pancreas 2020; 49:967-974. [PMID: 32658083 DOI: 10.1097/mpa.0000000000001610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The study concerns identifying risk factors and developing nomogram for pancreatic pseudocyst (PPC) in idiopathic chronic pancreatitis (ICP) to facilitate early diagnosis. METHODS From January 2000 to December 2013, ICP patients admitted to our center were enrolled. Cumulative incidence of PPC was determined by Kaplan-Meier method. Patients were randomized into training group and validation group in a 2:1 ratio. Risk factors of PPC were determined through Cox proportional hazards regression model based on training cohort. The nomogram was constructed according to risk factors. RESULTS Totally, 1633 ICP patients were included with a median follow-up duration of 9.8 years. Pancreatic pseudocyst was observed in 14.7% (240/1633) of patients after ICP onset. The cumulative incidences of PPC were 8.2%, 10.4%, and 12.9% at 3, 5, and 10 years after ICP onset, respectively. Male sex, smoking history, history of severe acute pancreatitis, and chronic pain at/before diagnosis of ICP and complex pathologic changes in main pancreatic duct were recognized as risk factors of PPC development. The nomogram constructed with these risk factors achieved good concordance indexes. CONCLUSIONS Risk for PPC could be estimated through the nomogram. High-risk patients were suggested to be followed up closely to help early diagnosis of PPC.
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Affiliation(s)
- Yu Liu
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Dan Wang
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Teng Wang
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Di Zhang
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Huai-Yu Yang
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Jia-Yi Ma
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Juan Li
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Ling-Ling Zhang
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Kun Lin
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Cui Chen
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Hong-Lei Guo
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Ya-Wei Bi
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing
| | - Lei Xin
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Xiang-Peng Zeng
- Department of Digestive Diseases, 900 Hospital of the Joint Logistics Team, Fuzhou
| | - Hui Chen
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing
| | - Zhuan Liao
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhao-Shen Li
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
| | - Liang-Hao Hu
- From the Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai
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Hu Y, Li C, Zhao X, Cui Y. An endoscopic or minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:471-480. [PMID: 31021167 DOI: 10.17235/reed.2019.5792/2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM the incidence of acute pancreatitis is rising across the world, thus further increasing the burden on healthcare services. Approximately 10% of patients with acute pancreatitis will develop infected necrotizing pancreatitis (INP), which is the leading cause of high mortality in the late phase. There is currently no consensus with regard to the use of endoscopic or minimally invasive surgery as the first-line therapy of choice for INP. However, more clinical research with regard to the superiority of an endoscopic approach has been recently published. Therefore, we conducted a systematic review and meta-analysis to determine which of the two treatments leads to a better prognosis. METHODS four databases (Medline, SINOMED, EMBASE and Cochrane Library) were searched for eligible studies from 1980 to 2018, comparing endoscopic and minimally invasive surgery for INP. RESULTS two randomized controlled trials (RCTs) and seven clinical cohort studies were included. After the analysis of data amenable to polling, significant advantages were found in favor of the endoscopic approach in terms of pancreatic fistulas (OR = 0.10, 95% CI 0.04-0.30, p < 0.001) and the length of hospital stay (weighted mean difference [WMD] = -24.72, 95% CI = -33.87 to -15.57, p < 0.001). No marked differences were found in terms of mortality, multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, recurrence of pseudocysts, and length of stay (LOS) in the Intensive Care Unit (ICU), endocrine insufficiency and exocrine insufficiency. CONCLUSION compared with minimally invasive surgery, an endoscopic approach evidently improved short-term outcomes for infected necrotizing pancreatitis, including pancreatic fistula and the length of hospital stay. Furthermore, relevant multicenter RCTs are eager to validate these findings.
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Affiliation(s)
- Yong Hu
- Surgery, Tianjin Medical University, china
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Endoscopic versus percutaneous drainage of post-operative peripancreatic fluid collections following pancreatic resection. HPB (Oxford) 2019; 21:434-443. [PMID: 30293867 PMCID: PMC7570452 DOI: 10.1016/j.hpb.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/24/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Post-operative peripancreatic fluid collection (PFC) is a common complication following pancreatic resection which can be managed with endoscopic or percutaneous drainage. METHODS Patients who underwent either endoscopic or percutaneous drainage of post-operative PFC were extracted from a prospectively-maintained database. The two groups were matched for surgery type, presence of a surgical drain and timing of drainage. RESULTS Thirty-nine matched patients were identified in each group with a median age of 62 years. For primary drainage, technical success was achieved in almost all patients in both endoscopic and percutaneous groups (100% and 97%, p = NS); clinical success was achieved in 67% and 59%, respectively (p = 0.63). At least one "salvage" drainage procedure was required in 13 endoscopic patients versus 16 in the percutaneous group. Clinical success was achieved following the first salvage. Procedure in 85% of the endoscopic patients and 88% of the percutaneous patients (p = 0.62). Stent/drain duration (59 vs 33 days, p < 0.001) and number of post-procedural CT studies (2 vs 1, p = 0.02) were significantly higher in the endoscopic group. There was no difference in length of stay, complication, or recurrence between the two groups. CONCLUSION Endoscopic drainage of post-operative PFC appears to be safe and effective with comparable success rates and outcomes to percutaneous drainage.
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Braden B, Koutsoumpas A, Silva MA, Soonawalla Z, Dietrich CF. Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using self-expanding metal stents without fluoroscopy. World J Gastrointest Endosc 2018; 10:93-98. [PMID: 29774088 PMCID: PMC5955727 DOI: 10.4253/wjge.v10.i5.93] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/20/2018] [Accepted: 03/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether endoscopic ultrasound (EUS)-guided insertion of fully covered self-expandable metal stents in walled-off pancreatic necrosis (WOPN) is feasible without fluoroscopy.
METHODS Patients with symptomatic pancreatic WOPN undergoing EUS-guided transmural drainage using self-expandable and fully covered self expanding metal stents (FCSEMS) were included. The EUS visibility of each step involved in the transmural stent insertion was assessed by the operators as “visible” or “not visible”: (1) Access to the cyst by needle or cystotome; (2) insertion of a guide wire; (3) introducing of the diathermy and delivery system; (4) opening of the distal flange; and (5) slow withdrawal of the delivery system until contact of distal flange to cavity wall. Technical success was defined as correct positioning of the FCSEMS without the need of fluoroscopy.
RESULTS In total, 27 consecutive patients with symptomatic WOPN referred for EUS-guided drainage were included. In 2 patients large traversing arteries within the cavity were detected by color Doppler, therefore the insertion of FCSEMS was not attempted. In all other patients (92.6%) EUS-guided transgastric stent insertion was technically successful without fluoroscopy. All steps of the procedure could be clearly visualized by EUS. Nine patients required endoscopic necrosectomy through the FCSEMS. Adverse events were two readmissions with fever and one self-limiting bleeding; there was no procedure-related mortality.
CONCLUSION The good endosonographic visibility of the FCSEMS delivery system throughout the procedure allows safe EUS-guided insertion without fluoroscopy making it available as bedside intervention for critically ill patients.
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Affiliation(s)
- Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
| | - Andreas Koutsoumpas
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
| | - Michael A Silva
- Hepatobiliary Surgery, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
| | - Zahir Soonawalla
- Hepatobiliary Surgery, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
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Gerosa M, Chiarelli M, Guttadauro A, De Simone M, Tagliabue F, Costa M, Terragni S, Cioffi U. Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation. BMC Gastroenterol 2018; 18:52. [PMID: 29685110 PMCID: PMC5913810 DOI: 10.1186/s12876-018-0781-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
Background Pancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak. Case presentation We describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution. Conclusion Pancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.
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Affiliation(s)
- Martino Gerosa
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Marco Chiarelli
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, 20900, Monza, Italy
| | - Matilde De Simone
- Department of Surgery, University of Milan, Via F. Sforza 35, 20122, Milan, Italy
| | - Fulvio Tagliabue
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Melchiorre Costa
- Department of Surgery, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Sabina Terragni
- Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, 20900, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Via F. Sforza 35, 20122, Milan, Italy.
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Hocke M, Braden B, Jenssen C, Dietrich CF. Present status and perspectives of endosonography 2017 in gastroenterology. Korean J Intern Med 2018; 33:36-63. [PMID: 29161800 PMCID: PMC5768548 DOI: 10.3904/kjim.2017.212] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound has become an essential tool in modern gastroenterology and abdominal surgery. Compared with all other endoscopic methods, it has the most potential for innovation and its future looks bright. Thus, we compiled this summary of established and novel applications of endoscopic ultrasound methods to inform the reader about what is already possible and where future developments will lead in improving patient care further. This review is structured in four parts. The first section reports on developments in diagnostic endoscopic ultrasound, the second looks at semi-invasive endoscopic ultrasound, and the third discusses advances in therapeutic endoscopic ultrasound. An overview on the future prospects of endoscopic ultrasound methods concludes this article.
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Affiliation(s)
- Michael Hocke
- Internal Medicine II, Helios Hospital Meiningen, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Christoph F. Dietrich
- Medical Department 2, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
- Correspondence to Christoph F. Dietrich, M.D. Medical Department 2, Caritas Hospital Bad Mergentheim, Uhlandstraße 7, Bad Mergentheim 97980, Germany Tel: +49-7931-582201 Fax: +49-7931-582290 E-mail:
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Yoshimatsu G, Shahbazov R, Saracino G, Lawrence MC, Kim PT, Onaca N, Beecherl EE, Naziruddin B, Levy MF. The impact of allogenic blood transfusion on the outcomes of total pancreatectomy with islet autotransplantation. Am J Surg 2017; 214:849-855. [DOI: 10.1016/j.amjsurg.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 02/07/2023]
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Guo J, Saftoiu A, Vilmann P, Fusaroli P, Giovannini M, Mishra G, Rana SS, Ho S, Poley JW, Ang TL, Kalaitzakis E, Siddiqui AA, De La Mora-Levy JG, Lakhtakia S, Bhutani MS, Sharma M, Mukai S, Garg PK, Lee LS, Vila JJ, Artifon E, Adler DG, Sun S. A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. Endosc Ultrasound 2017; 6:285-291. [PMID: 29063871 PMCID: PMC5664848 DOI: 10.4103/eus.eus_85_17] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-off necrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peri-pancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pietro Fusaroli
- Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | | | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sammy Ho
- Montefiore Medical Center, New York, USA
| | - Jan-Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tiing Leong Ang
- Gastroenterology Department, Changi General Hospital, Singapore
| | - Evangelos Kalaitzakis
- Endoscopy Unit, Digestive Disease Center, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ali A Siddiqui
- Division of Digestive and Liver Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, USA
| | - Manoop S Bhutani
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Pramod Kumar Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Douglas G Adler
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
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Kitamura K, Yamamiya A, Ishii Y, Nomoto T, Honma T, Yoshida H. Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage. World J Gastrointest Endosc 2016; 8:458-465. [PMID: 27433292 PMCID: PMC4937161 DOI: 10.4253/wjge.v8.i13.458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/02/2016] [Accepted: 06/02/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography (EUS)-guided pancreatic fluid collection drainage.
METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage (EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections (PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter (electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter (non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.
RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients (87%) in the electrocautery group and 10 patients (77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100% (15/15) and 100% (13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67% (10/15) and 69% (9/13) for the electrocautery and the non-electrocautery groups, respectively (P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group (mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively (P = 0.942).
CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.
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Theoretical approach to local infusion of antibiotics for infected pancreatic necrosis. Pancreatology 2016; 16:719-25. [PMID: 27267056 DOI: 10.1016/j.pan.2016.05.396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/03/2016] [Accepted: 05/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Infected pancreatic necrosis is a major complications of acute pancreatitis. If drainage is required, local administration of antibiotics through transmural nasocystic or percutaneous catheter may allow increasing local antibiotic concentrations. Drug diffusion becomes the main factor influencing local drug tissue penetration. The present study aims at providing the rationale for the design of new research protocols evaluating the efficacy of local antibiotics for infected pancreatic necrosis. METHODS A review of microbiological data was performed for the most common organisms causing the infection, antibiotics spectrum and minimum inhibitory concentrations (MIC). A search of the physico-chemical properties of antibiotics was performed to calculate the diffusion coefficients. An estimation of the antibiotic concentrations in pancreatic tissue was obtained using a mathematical model. Efficacy factors (EF) were calculated and the stability of the antibiotic solutions were evaluated to optimize the dosing regimen. RESULTS Piperacillin, vancomycin and metronidazole achieve high concentrations in the surrounding tissue very fast. Imipenem, ceftriaxone, ciprofloxacin, gentamicin, linezolid and cloxacillin achieve intermediate concentration values. Tigecycline, showed the lowest concentration values (<2 mg/L). Calculated EF is highest for piperacillin and imipenem short after administration and near to surface diffusion area (0.5 cm), but EF of imipenem is higher at deeper areas and longer time after administration. CONCLUSIONS Considering obtained results, some solutions are proposed using saline as diluent and 25 °C of temperature during administration. Imipenem has the best theoretical results in empiric local treatment. Linezolid and tigecycline solutions are not recommended.
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Mangiavillano B, Pagano N, Baron TH, Arena M, Iabichino G, Consolo P, Opocher E, Luigiano C. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World J Gastrointest Endosc 2016; 8:143-156. [PMID: 26862364 PMCID: PMC4734973 DOI: 10.4253/wjge.v8.i3.143] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/01/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents.
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Zerem E, Hauser G, Loga-Zec S, Kunosić S, Jovanović P, Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World J Gastroenterol 2015; 21:6850-6860. [PMID: 26078561 PMCID: PMC4462725 DOI: 10.3748/wjg.v21.i22.6850] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/29/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023] Open
Abstract
A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity.
Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.
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Casasola-Sánchez LE, Téllez-Ávila FI. El papel terapéutico del ultrasonido endoscópico en las colecciones líquidas peripancreáticas. ENDOSCOPIA 2015. [DOI: 10.1016/j.endomx.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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