Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report

Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms

With the development of cross-sectional imaging modalities and the increasing attention being paid to physical examinations, the prevalence of pancreatic cystic neoplasms (PCNs) has increased. PCNs comprise a broad differential spectrum with some PCNs having low or no malignant potential and others having high malignant potential. The morbidity and mortality rates related to major pancreatic surgical resection are high. Long-term surveillance may not only increase the financial burden and psychological stress for patients but also result in a missed malignancy. Minimally invasive endoscopic ultrasound (EUS)-guided ethanol ablation was first reported in 2005. Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs. These ablative agents are injected through a needle inserted into the cyst via transgastric or transduodenal puncture. This treatment method has been substantially developed in the last 15 years and is regarded as a promising treatment to replace surgical resection for PCNs. While several reviews of EUS-guided ablation have been published, no systematic review has evaluated this method from patient preparation to follow-up in detail. In the present review, we systematically describe EUS-guided injective ablation with regard to the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives.

Benign Duodenal Stricture Treated with Surgical Correction and Dietary Therapy in a Golden Retriever

A benign duodenal stricture is a well-documented condition of humans that has not been characterized in dogs. In this case report, the clinical, radiographic, ultrasonographic, endoscopic, surgical, and histopathologic findings of a single benign duodenal stricture in a Golden Retriever are reported. Definitive diagnosis was made possible with the utilization of esophagogastroduodenoscopy (EGD). Surgical correction of the stricture, paired with dietary therapy that utilized a highly digestible diet, resolved the clinical signs in the case reported. Several inciting causes were identified as possible drivers of stricture formation, including nonsteroidal anti-inflammatory drug (NSAID) administration, mucosal ulceration, traumatic injury, or inflammatory intestinal disease. A benign duodenal stricture should be considered an infrequent cause of intermittent, chronic gastrointestinal signs that may have a favorable outcome via surgical correction and dietary management.