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Ghoneem E, Okasha H, Hammouda M, Gouda MF, Soliman R, Shiha G, Ragab K, Agwa RH. Technical and Clinical Outcomes of Using a Single Wide-Caliber Double-Pigtail Stent for Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage: A Multicenter Prospective Study. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:414-421. [PMID: 38476158 PMCID: PMC10928872 DOI: 10.1159/000526852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/25/2022] [Indexed: 11/14/2023]
Abstract
Introduction Endoscopic ultrasound (EUS)-guided pancreatic cysto-gastrostomy/duodenostomy is the current accepted practice for management of symptomatic pancreatic pseudocysts with insertion of two or more double-pigtail (DP) stents. There is no much work on the efficacy of using a single wide-caliber DP stent, aiming to decrease the time, complications, and accessories used in the procedure. Aim of the Work The aim of this study was to assess technical and clinical outcomes of using a single wide-caliber DP stent in EUSguided pancreatic pseudocyst drainage. Methodology This multicenter prospective study included 57 patients, from which the 35 patients with symptomatic pancreatic pseudocysts enrolled. Patients with cysts with multiple septations (7 cases) or cyst with >30% necrosis (8 cases) of the cyst content and patients with generalized ascites (4 cases) or patients with major comorbidities (3 cases) were excluded. Patients were followed up within 1 month and 6 months after stent placement to assess complete resolution or a decrease in the sizes of cysts with clinical symptomatic improvement. Results From 57 patients, 35 patients (19 females/16 males, median age 40 years) with a symptomatic pancreatic pseudocyst were referred for EUS-guided drainage. All used stents were 10 Fr DP plastic stents. The median duration of the whole procedure was 16 min. Technical success was achieved in all cases. Clinical success was encountered in 32 patients (91.4%) without re-accumulation on follow-up. Minor adverse events were encountered in 3 patients (8.6%) including post-procedure abdominal pain (1 case) and fever (2 cases). Conclusion We suggest that using a wide-caliber single-pigtail stent for EUS-guided cystogastrostomy is safe and effective with short procedure time, with reduced risks from the insertion of another stent(s).
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Affiliation(s)
- Elsayed Ghoneem
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Hussein Okasha
- Hepatology and Gastroenterology Unit, Kasr al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hammouda
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Reham Soliman
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Gamal Shiha
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Khaled Ragab
- Theodor Bilharz Research Institute, Cairo, Egypt
| | - Ramy Hassan Agwa
- Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Zhang HM, Ke HT, Ahmed MR, Li YJ, Nabi G, Li MH, Zhang JY, Liu D, Zhao LX, Liu BR. Endoscopic transgastric fenestration versus percutaneous drainage for management of (peri)pancreatic fluid collections adjacent to gastric wall (with video). World J Gastroenterol 2023; 29:5557-5565. [PMID: 37970477 PMCID: PMC10642437 DOI: 10.3748/wjg.v29.i40.5557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/01/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Percutaneous drainage (PCD) and endoscopic approaches have largely replaced surgical drainage as the initial approach for (peri) pancreatic fluid collections (PFC)s, while complications associated with endoscopic stent implantation are common. AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration (ETGF), which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation, and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall. METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled. Indications for intervention were consistent with related guidelines. We analyzed patients baseline characteristics, technical and clinical success rate, recurrence and reintervention rate, procedure-related complications and adverse events. RESULTS Seventy-two eligible patients were retrospectively identified (ETGF = 34, PCD = 38) from October 2017 to May 2021. Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group (97.1 vs 76.3%, P = 0.01). There were no statistically significant differences regarding recurrence, reintervention and incidence of complication between the two groups. While long-term catheter drainage was very common in the PCD group. CONCLUSION Compared with PCD, ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall. ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.
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Affiliation(s)
- Hong-Mei Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Hui-Ting Ke
- Department of Ultrasound, Ezhou Central Hospital, Ezhou 436099, Hubei Province, China
| | - Md Robin Ahmed
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ya-Juan Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow 31120, Poland
| | - Mu-Han Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Teoh JYC, Cho CL, Chan RCK, Liu K, Zhao H, Giannarini G, Enikeev D, Ng CF, Teoh AYB. A proof-of-concept study on endoscopic ultrasound-guided biopsy of detrusor muscle in porcine bladders. Front Oncol 2023; 13:1160463. [PMID: 37333813 PMCID: PMC10272740 DOI: 10.3389/fonc.2023.1160463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Conventionally, we rely on transurethral resection of bladder tumour (TURBT) for local staging of muscle-invasive bladder cancer (MIBC). However, the procedure is limited by its staging inaccuracy which may delay the definitive treatment of MIBC. Methods We conducted a proof-of concept study on endoscopic ultrasound (EUS)-guided biopsy of detrusor muscle in porcine bladders. Five porcine bladders were used in this experiment. Upon EUS, four layers of tissue including the mucosa (hypoechoic), submucosa (hyperechoic), detrusor muscle (hypoechoic) and serosa (hyperechoic) could be identified. Results A total of 37 EUS-guided biopsies were taken from 15 sites (three sites per bladder), and the mean number of biopsies taken from each site was 2.47±0.64. Among the 37 biopsies, 30 of them (81.1%) obtained detrusor muscle in the biopsy specimen. For the per biopsy site analysis, detrusor muscle was obtained in 73.3% if only one biopsy was taken, and 100% if two or more biopsies were taken from the same biopsy site. Overall, detrusor muscle was successfully obtained from all 15 biopsy sites (100%). No bladder perforation was observed throughout all biopsy processes. Conclusion EUS-guided biopsy of the detrusor muscle could be performed during the initial cystoscopy session, thus expediting the histological diagnosis and subsequent treatment of MIBC.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Urothelial Carcinoma Working Group, European Association of Urology – Young Academic Urologists (EAU-YAU), Arnhem, Netherlands
| | - Chak-Lam Cho
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kang Liu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Gianluca Giannarini
- Urology Unit, “Santa Maria della Misericordia” University Hospital, Udine, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Yuen-Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Varvoglis DN, Sanchez-Casalongue M, Baron TH, Farrell TM. "Orphaned" Stomach-An Infrequent Complication of Gastric Bypass Revision. J Clin Med 2022; 11:7487. [PMID: 36556106 PMCID: PMC9782235 DOI: 10.3390/jcm11247487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an "orphaned" segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately proved the diagnosis, and the issue was successfully treated using a combination of surgical and endoscopic methods to control the abscess and to allow internal drainage.
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Affiliation(s)
- Dimitrios N. Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | | | - Todd H. Baron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Timothy M. Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis. Case Rep Radiol 2021; 2021:1919550. [PMID: 34888110 PMCID: PMC8651394 DOI: 10.1155/2021/1919550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.
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Sundaram S, Choksi D, Kale A, Giri S, Patra B, Bhatia S, Shukla A. Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome. Clin Endosc 2021; 54:903-908. [PMID: 33657781 PMCID: PMC8652154 DOI: 10.5946/ce.2020.297] [Citation(s) in RCA: 1] [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: 11/09/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background/Aims Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Results Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
Conclusions The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.
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Affiliation(s)
- Sridhar Sundaram
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Dhaval Choksi
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Biswaranjan Patra
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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Gupta P. Percutaneous catheter drainage of walled-off necrosis in acute pancreatitis: "Not so inferior" to endoscopic or surgical drainage. Pancreatology 2020; 20:1023. [PMID: 32571535 DOI: 10.1016/j.pan.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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Kazim E, Taj MA, Zulfikar I, Azeem J. Endoscopic Ultrasound Guided Pancreatic Pseudocyst drainage experience at a tertiary care unit. Pak J Med Sci 2020; 36:637-641. [PMID: 32494247 PMCID: PMC7260908 DOI: 10.12669/pjms.36.4.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the clinical success, technical success and complications related to Endoscopic ultrasound (EUS) guided Pancreatic pseudocyst (PPC) drainage. Methods: This retrospective study was conducted on the patients with symptomatic PPC who presented over a period of three years, between January 2015 and September 2018, at Endoscopic Suite of Surgical Unit 4, Civil Hospital, Karachi. Record was analyzed for demographic data, indications for the procedure, complications and success related to EUS guided drainage. Statistical analyses were performed using the SPSS Version 22. Results: Total number of patients was 71. Mean age was 37.20 ± 17.27 years with a range of 6 to 68 years. Complications occurred in 12 (8.52%) patients, including stent migration (5/12), bleeding (4/12), infection (1/12), intra-abdominal abscess (1/12) and perforation (1/12). Technical success was achieved in 100% and clinical success in 97.1%. There was no procedure-related mortality. Conclusion: Pancreatic pseudocyst (PPC) is a known complication of acute as well as chronic pancreatitis which can have dreaded and appalling effects. In this part of the world with limited and scarce resources, EUS guided drainage of PPC is most feasible and rational with minimal complications, thus making it a front runner procedure.
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Affiliation(s)
- Erum Kazim
- Dr. Erum Kazim, FCPS. Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Ali Taj
- Dr. Muhammad Ali Taj, MRCP, Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Imrana Zulfikar
- Dr. Imrana Zulfikar, FCPS. Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Azeem
- Dr. Jawwad Azeem, SMO. Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
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[Retrieval of a migrated plastic stent in a 51-year-old man]. Internist (Berl) 2018; 59:1100-1105. [PMID: 29663019 DOI: 10.1007/s00108-018-0418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Endosonographically guided transgastric drainage is the first-line interventional therapy of walled-off necrosis and symptomatic pancreatic pseudocysts in necrotizing pancreatitis. Plastic stents or lumen apposing metal stents are commonly used. A possible complication of endoscopic therapy is stent migration. CASE REPORT We report upon a 51-year-old man who presented with acute necrotizing pancreatitis. Transgastric necrosectomy was performed and 5 transmural double-pigtail stents (DPS) were left in situ to drain the residual retroperitoneal cavity. The patient recovered and 4 stents were endoscopically removed 5 weeks later on an outpatient basis, whereas the fifth stent was suspected to have passed spontaneously via the natural route. The asymptomatic patient presented 3 months later for follow-up computed tomography. The necrosis had healed but one DPS was seen beyond the gastric wall near the kidney. Transmural access to the stent could be achieved by an endosonographically guided puncture toward the proximal portion of the stent followed by placement of a hydrophilic guidewire alongside the stent. A new gastrostomy was created by using a 6F cystotome followed by wire-guided dilation with a 12 mm balloon. The stent could then be grasped with transmurally inserted rat-tooth forceps and repositioned across the gastrostomy site. The patient was given prophylactic antibiotics. After removal of the stent, the patient could be discharged. CONCLUSION Herein, we present the successful endosonographically guided transmural removal of a retroperitoneally migrated plastic stent. Of note, in our patient we had to rely completely on endosonography and radiography for localization and targeting of the stent, since the former necrotic cavity had meanwhile completely healed.
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017; 5:213-219. [PMID: 29340278 DOI: 10.1515/jtim-2017-0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017. [PMID: 29340278 DOI: 10.1515/jtim-2017-0036.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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Abstract
OPINION STATEMENT Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting.
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Sun B, Guo J, Ge N, Sun S, Wang S, Liu X, Wang G, Feng L. Endoscopic ultrasound-guided puncture suture device versus metal clip for gastric defect closure after endoscopic full-thickness resection: A randomized, comparative, porcine study. Endosc Ultrasound 2016; 5:263-8. [PMID: 27503160 PMCID: PMC4989409 DOI: 10.4103/2303-9027.187891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The secure closure of the wall defect is a critical stage of endoscopic full-thickness resection (EFTR). The aim of this study was to compare the closure of post-EFTR defects using an endoscopic ultrasound-guided puncture suture device (PSD) with the metal clip (MC) technique in a randomized, comparative, porcine study. Methods: We performed a randomized comparative survival study that included 18 pigs. The circular EFTR defects with a diameter of approximately 20 mm were closed with either a PSD or MC. Serum levels of interleukin-6 (IL-6) were determined preoperatively and on a postoperative day (POD) 1, 3, and 7. Three animals from each group were sacrificed at the end of the 7th, 14th, and 30th POD. Tissue samples retrieved from the closure sites were examined macroscopically and microscopically. Results: Resection and closure were performed in 18 pigs (100%) without major perioperative complications. The mean closure time was significantly longer in the MC group than in the PSD group (25.00 ± 3.16 min vs. 1.56 ± 0.39 min; P < 0.05). Preoperative and POD 7 serum levels of IL-6 did not differ between the two groups. However, on POD 1, the IL-6 levels were observed to be significantly greater in the MC group than in the PSD group (P < 0.005). No significant differences between the PSD and MC groups were observed at necropsy. Conclusion: In this in vivo porcine model, PSD is a feasible device that achieves post-EFTR defect closure with a much shorter closure time and with less immunological responses than the MC technique.
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Affiliation(s)
- Beibei Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
| | - Linlin Feng
- Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China
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Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts. Gastroenterol Res Pract 2016; 2016:1249064. [PMID: 27313606 PMCID: PMC4904102 DOI: 10.1155/2016/1249064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/14/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022] Open
Abstract
Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted. Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n = 13) and pelvic abscesses (n = 4). The median lesion size was 7.1 cm (range: 2.8-13.0 cm), and the mean time spent per procedure was 26.2 ± 9.8 minutes (range: 16-50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution. Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.
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Li A, Cao F, Li J, Fang Y, Wang X, Liu DG, Li F. Step-up mini-invasive surgery for infected pancreatic necrosis: Results from prospective cohort study. Pancreatology 2016; 16:508-14. [PMID: 27083075 DOI: 10.1016/j.pan.2016.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/29/2016] [Accepted: 03/19/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the clinical efficacy and success predictors of mini-invasive techniques in the treatment of infected pancreatic necrosis (IPN). METHODS IPN patients admitted to our clinic for treatment by mini-invasive techniques were included in this study prospectively. Treatment was divided into four sequential phases: percutaneous catheter drainage (PCD), mini-incision drainage (MID), video assisted debridement (VAD) and open surgery. Patients progressed to next phase if the infection cannot be controlled. The frequency of surgery, treatment duration, cure rate, incidence of complication and overall mortality were recorded. Risk factors for failure of PCD and MID procedures were detected by logistic regression including demographics, disease severity and morphologic characteristics. RESULTS From January 2012 to March 2015, a total of 54 consecutive IPN patients were treated, with an average age of 51.2 ± 3.1 years. Of the 54 cases, 18 (33.3%) were cured after PCD; 13 (24.1%) with uncontrolled infection were cured after MID; and the remaining 19 cases (35.2%) were cured after VAD. No open surgery was performed. Overall mortality was 7.4% (4/54), and the incidence of complications was 12.9% (7/54). In multivariable regression, the following factors were associated with high failure rate for both PCD and MID: heterogeneous fluid collection (odds ratio (OR) = 3.14; 95% confidence interval (CI): 1.32 ~ 4.25, P = 0.001 for PCD; OR = 2.99; 95% CI: 1.52 ~ 5.10, P = 0.006 for MID), multiple infected collections (OR = 4.51; 95% CI: 2.94 ~ 8.63; P = 0.000 for PCD; OR = 4.17; 95% CI: 2.77 ~ 8.12, P = 0.000 for MID), CT severity index (0 ~ 3/4 ~ 6/7 ~ 10: OR = 2.16; 95% CI: 1.83 ~ 3.62, P = 0.031 for PCD; OR = 2.72; 95% CI: 1.78 ~ 4.10, P = 0.005 for MID). CONCLUSIONS Step-up mini-invasive techniques can be considered a first choice in the treatment of IPN. CT is effective to predict success of PCD and MID.
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Affiliation(s)
- Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Yu Fang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Xiaohui Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Dian-Gang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China.
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Affiliation(s)
- Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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