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Xu N, Li LS, Yue WY, Zhao DQ, Xiang JY, Zhang B, Wang PJ, Cheng YX, Linghu EQ, Chai NL. Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports. World J Gastrointest Surg 2022; 14:855-861. [PMID: 36157367 PMCID: PMC9453336 DOI: 10.4240/wjgs.v14.i8.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/27/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections (PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.
CASE SUMMARY Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography (CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.
CONCLUSION Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.
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Affiliation(s)
- Ning Xu
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Wen-Yi Yue
- Department of Radiology, Chinese PLA General Medical School, Beijing 100853, China
| | - Dan-Qi Zhao
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jing-Yuan Xiang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Peng-Ju Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Ya-Xuan Cheng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
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Bizzarri B, Nervi G, Ghiselli A, Manzali E, Di Mario F, Leandro G, Gaiani F, Kayali S, De' Angelis GL. Endoscopic ultrasound in pediatric population: a comprehensive review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:33-39. [PMID: 30561393 PMCID: PMC6502188 DOI: 10.23750/abm.v89i9-s.7876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 12/19/2022]
Abstract
Background and aim: Endoscopic ultrasonography (EUS) with or without fine needle aspiration/biopsy (FNA/B) is a well-established diagnostic tool in adults for the evaluation and management of gastrointestinal (GI) tract disorders. Its use in children is still limited as well as literature in pediatric age is limited, although the application of EUS is now increasing. The present article aims to review the current literature about EUS indication, accuracy and safety in pediatric age. Methods: Electronic literature searches were conducted using Pubmed, Medline, Embase, and the Cochrane Central Register of Controlled Trials using the word pediatric endoscopic ultrasound, pediatric pancreaticobiliary AND/OR EUS, pediatric EUS technique. Main patients and procedures characteristics were analyzed. The primary endpoint was the indication of EUS. Secondary endpoints were the accuracy of the technique and the incidence of complications. Results: Data were extracted from 19 articles. A total of 571 patients were investigated, with a median age of 12,7 years. A total of 634 EUS procedures were performed. The majority of EUS procedures investigated the pancreaticobiliary tract (77,7%). Most studies showed a high positive impact on management with a median value of 81,7%. No major complications were reported. Five studies reported minor complications with a median value of 2%. Conclusions: EUS is safe and has a significant role in the diagnosis of pancreaticobiliary and GI diseases even in children, with a high therapeutic success. An increasing EUS utilization by pediatric gastroenterologists is expected and offering dedicated EUS training to some selected pediatric gastroenterologists might be indicated. (www.actabiomedica.it)
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Affiliation(s)
- Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Jagannath S, Garg PK. Recurrent Acute Pancreatitis: Current Concepts in the Diagnosis and Management. ACTA ACUST UNITED AC 2018; 16:449-465. [PMID: 30232693 DOI: 10.1007/s11938-018-0196-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW There have been significant developments in the diagnosis, clinical approach, and management of patients with recurrent acute pancreatitis (RAP) in the last decade. This review systematically summarizes our current understanding of RAP. NEW FINDINGS Gallstones and alcohol are common causes of RAP. Non-alcohol non-biliary RAP (nAnB RAP) is a difficult group of patients after excluding these two causes because extensive workup is required to elucidate the etiology. Idiopathic RAP is diagnosed after excluding all the known causes and recurrence is noted to be higher in such patients. Patients with non-biliary RAP are prone to develop chronic pancreatitis (CP) suggesting a continuum from acute to recurrent to chronic pancreatitis. Often, patients destined to develop CP present at an earlier stage with RAP. Endoscopic ultrasound and magnetic resonance cholangiopancreatography (MRCP) are the investigations of choice to detect microlithiasis, choledocholithiasis, ductal abnormalities, peri-ampullary malignancies, and early changes of chronic pancreatitis. The role of pancreas divisum, sphincter of Oddi dysfunction, and anomalous pancreatobiliary union in causing RAP is controversial. Genetic testing may be advisable in younger patients. CONCLUSION With a focused approach and appropriate investigations, the etiology of RAP can be identified in a significant proportion of patients. Therapeutic options are limited and future research is needed to improve understanding of the disease.
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Affiliation(s)
- Soumya Jagannath
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Garg PK, Narayana D. Changing phenotype and disease behaviour of chronic pancreatitis in India: evidence for gene-environment interactions. Glob Health Epidemiol Genom 2016; 1:e17. [PMID: 29868209 PMCID: PMC5870434 DOI: 10.1017/gheg.2016.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The idiopathic variety of chronic pancreatitis (CP) in India particularly in Kerala state was earlier called 'tropical pancreatitis' with peculiar features: early age of onset, severe malnutrition, diabetes and poor prognosis. A change in disease phenotype and behaviour has been observed recently. OBJECTIVE To review the changing profile of CP in India and examine its relationship with environmental influences and socio-economic development. METHODS Relevant studies on CP in India were reviewed along with social and economic parameters in Kerala over the past 4 decades. RESULTS There has been a definite change in the phenotype of CP in India with onset in mid twenties, better nutritional status, and a much better prognosis compared with the reports in 1970s. Genetic susceptibility due to genetic mutations particularly in SPINK1, CFTR, CTRC, and CLDN2/MORC4 genes is the most important factor and not malnutrition or dietary toxins for idiopathic CP suggesting the term 'tropical pancreatitis' is a misnomer. We observed a close relationship between socio-economic development and rising income in Kerala with late onset of disease, nutritional status, and better prognosis of CP. CONCLUSION Changing profile of CP in India and better understanding of risk factors provide evidence for gene-environmental interactions in its pathobiology.
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Affiliation(s)
- P. K. Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - D. Narayana
- State Planning Board, Government of Kerala, India
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Yin HK, Wu HE, Li QX, Wang W, Ou WL, Xia HHX. Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study. Gastroenterol Res Pract 2016; 2016:9687052. [PMID: 27057161 PMCID: PMC4789431 DOI: 10.1155/2016/9687052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/18/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background. Endoscopic retrograde cholangiopancreatography (ERCP) is an established treatment modality for bile duct disorders, but patients have a risk of post-ERCP pancreatitis (PEP) and biliary sepsis. Aim. To evaluate the effectiveness and safety of pancreatic stent for prophylaxis of PEP and biliary sepsis in high-risk patients with complicating common bile duct (CBD) disorders. Methods. Two hundred and six patients with complicating confirmed or suspected CBD disorders were randomly assigned to receive ERCP with pancreatic stenting (experimental group) or without stenting (control group). Primary outcome measure was frequency of PEP, and secondary outcome measures included operative time, blood loss, postoperative recovery times, and other ERCP-associated morbidities. Results. Baseline age, sex, CBD etiology, concomitant medical/surgical conditions, cannulation difficulty, and ERCP success were comparable between the two groups (all P > 0.05). Compared to the control group, the experimental group had a significantly lower frequency of PEP (7.7% versus 17.7%, P < 0.05) and positive bile microbial culture (40.4% versus 62.7%, P < 0.05). However, the two groups were similar in operative time, blood loss, postoperative recovery times, and other ERCP-associated morbidities (all P > 0.05). Conclusions. Pancreatic stenting can reduce the occurrence of PEP and biliary sepsis in high-risk patients with complicating CBD disorders but does not increase other ERCP-associated morbidities. This trial is registered with the Chinese Clinical Trial Registry (registration identifier ChiCTR-OCH-14005134).
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Affiliation(s)
- He-Kun Yin
- Department of Gastroenterology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
- *He-Kun Yin:
| | - Hai-En Wu
- Department of Gastroenterology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Qi-Xiang Li
- Department of Gastroenterology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Wei Wang
- Department of Gastroenterology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Wei-Lin Ou
- Department of Gastroenterology, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Harry Hua-Xiang Xia
- Department of Gastroenterology, The First Hospital Affiliated to Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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Fusaroli P, Caletti G. Is there a role for celiac plexus block for chronic pancreatitis? Endosc Int Open 2015; 3:E60-2. [PMID: 26134774 PMCID: PMC4423247 DOI: 10.1055/s-0034-1391392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/11/2014] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pietro Fusaroli
- Department of Gastroenterology, University of Bologna, Imola, Italy,Corresponding author Pietro Fusaroli, MD Department of GastroenterologyUniversity of BolognaVia Montericco 4ImolaItaly+39-05-426-62409
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Ang TL, Eu Kwek AB, Fock KM, Teo EK. Endoscopic ultrasound-guided insertion of a large diameter fully covered self-expandable metallic stent as rescue therapy for recurrent infected walled off pancreatic necrosis after surgical necrosectomy. Endosc Ultrasound 2014; 3:245-8. [PMID: 25485273 PMCID: PMC4247533 DOI: 10.4103/2303-9027.144544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/16/2014] [Indexed: 01/10/2023] Open
Abstract
A 39-year-old man developed severe necrotizing gallstone pancreatitis complicated by infected pancreatic necrosis. Surgical necrosectomy was performed to control the on-going sepsis. Subsequently, there was a recurrence of an infected necrotic collection at the site of surgical necrosectomy, in the region of the pancreatic body and tail. He did not respond to conservative treatment with intravenous antibiotics. Pancreatic duct stenting was performed to treat pancreatic duct leak, followed by endoscopic ultrasound guided insertion of a large diameter fully covered self-expandable metallic stent to drain the infected collection. There was rapid and complete clinical recovery.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Ge N, Wang Z, Sun S, Wang S, Wang G, Sun S, Feng L, Yang F, Ma W, Wang S, Liu X, Guo J, Liu W. EUS assisted transmural cholecystogastrostomy fistula creation as a bridge for endoscopic internal gallbladder therapy using a novel fully covered metal stent. BMC Gastroenterol 2014; 14:164. [PMID: 25249425 PMCID: PMC4189557 DOI: 10.1186/1471-230x-14-164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/16/2014] [Indexed: 12/18/2022] Open
Abstract
Background Laparoscopic cholecystectomy (LC) has become the “gold standard” for treating symptomatic gallstones. Innovative methods, such as a scarless therapeutic procedure through a natural orifice are being introduced, and include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. The aim of this study was to evaluate the feasibility of endoscopic internal gallbladder therapy such as cholecystolithotomy in an animal survival model. Methods Four pigs underwent endoscopic-ultrasound (EUS)-guided cholecystogastrostomy and the placement of a novel covered mental stent. Four weeks later the stents were removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy was performed. Two weeks later the pigs were sacrificed, and the healing of the fistulas was assessed. Results EUS-guided cholecystogastrostomy with mental stent deployment was successfully performed in all the animals. Four weeks after the procedure, the fistulas had formed and all the stents were removed. Endoscopic cholecystolithotomy was performed through each fistula. All the animals survived until they were sacrificed 2 weeks later. The fistulas were found to be completely healed. Conclusions This study reports the first endoscopic transmural cholecystolithotomy after placement of a novel mental stent in an animal survival model.
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Affiliation(s)
| | | | - Siyu Sun
- Endoscopy center, Shengjing Hospital, Shenyang, China.
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