Endoscopic Pancreatic Duct Stent Placement Research Articles

Pancreatic duct stents.

Pancreatic duct stenting using endoscopy or surgery is widely used for the management of benign and malignant pancreatic diseases. Endoscopic pancreatic stents are mainly used to relieve pain caused by chronic pancreatitis and pancreas divisum, and to treat pancreatic duct disruption and stenotic pancreaticointestinal anastomosis after surgery. They are also used to prevent postendoscopic retrograde cholangiopancreatography pancreatitis and postoperative pancreatic fistula, treat pancreatic cancer, and locate radiolucent stones. Recent advances in endoscopic techniques, such as endoscopic ultrasonography and balloon enteroscopy, and newly designed stents have broadened the indications for pancreatic duct stenting. In this review we outlined the types, insertion procedures, efficacy, and complications of endoscopic pancreatic duct stent placement, and summarized the applications of pancreatic duct stents in surgery.

Pancreaticopleural fistula in a child with chronic pancreatitis harboring compound SPINK1 variants

BackgroundPancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis (CP) that requires a high index of clinical suspicion in the patient who presents with a pleural effusion. Visualizing the fistula tract from the pancreatic duct to the pleural space by radiological imaging provides confirmation of this complication.Case presentationA 9-year-old boy who presented with massive right pleural effusion secondary to PPF, a complication of CP from a genetic mutation involving two mutations of SPINK1. We successfully managed the case with by endoscopic pancreatic duct stent placement after failure of conservative treatment approaches.ConclusionsPPF is a rare but serious complication of CP in all ages. The diagnosis of PPF in children requires a high index of clinical suspicion and should be considered in the differential diagnosis of massive pleural effusion where pancreatic pathology is present. A high level of pleural fluid amylase and the results from radiological imaging when the patients have symptoms play essential roles in the diagnosis of PPF. Currently, Magnetic resonance cholangiopancreatigraphy (MRCP) is the imaging modality of choice. Endoscopic therapy and surgery are treatment options for patients who do not respond to conservative therapy.

2141 “Knock Out” Pancreas: An Unusual Case of Isolated Pancreatic Duct Laceration in a Mixed Martial Arts Fighter

INTRODUCTION: Isolated Pancreatic duct laceration due to blunt trauma to the abdomen is very rare. Diagnosis requires a high level of suspicion as delay in diagnosis can lead to complications such as pseudocyst, abscess and duct stricture. We present an unusual case of pancreatic duct laceration complicated with pseudocyst formation due to blunt trauma to the abdomen during a Mixed Martial Arts fight. CASE DESCRIPTION/METHODS: 33-year-old MMA fighter with no past medical history sustained a blunt trauma to the abdomen during a fight resulting in a knockout. Patient was emergently transferred to the hospital for evaluation. Lab work revealed elevated lipase >2000 IU consistent with acute traumatic pancreatitis. CT of the abdomen revealed diffuse edema of the pancreas with suspicion for possible laceration of the pancreatic duct. Patient was conservatively managed and later discharged once pain improved. Patient continued to have abdominal pain and returned to the emergency room 3 months later with abdominal distention associated with nausea and vomiting. Repeat CT of the abdomen revealed a 13 cm × 12.5 cm cystic lesion around the body of the pancreas with communication with the pancreatic duct (Image 1,2). MRI revealed a large cystic lesion with potential communication with the pancreatic duct seen on T2 images (Image 3).An ERCP was attempted but due to the mechanical compression caused by the cyst, the ampulla could not be accessed. An Endoscopic Ultrasound guided placement of a 10 × 10 mm cyst gastrostomy stent resulted in successful drainage of the pancreatic pseudocyst. Patient was later discharged and followed up in 1 month with repeat imaging showing complete resolution of the cyst. Endoscopy was repeated 4 weeks later with removal of the cystgastrostomy stent. Patient has since been doing well and awaits ERCP to evaluate the anatomy of the pancreatic duct. DISCUSSION: Isolated laceration of the pancreatic duct due to blunt trauma to the abdomen is very rare. Sudden severe impact to the abdomen, such as a punch, compresses the pancreas against the vertebral column resulting in pancreatic laceration. Diagnosis requires a high degree of suspicion and imaging confirmation. Management can be challenging as most pancreatic duct lacerations are often missed resulting in complications such as in our patient. There have been case reports of successful management with early endoscopic pancreatic duct stent placement. Refractory cases often require complex abdominal surgeries such as pancreatico - jejunostomy.

Endoscopic Treatment of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations.

Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is a rare complication associated with significant morbidity and mortality. This study evaluated endoscopic management experience and outcomes of ERCP-related duodenal perforations. Between March 2005 and March 2017, a total of 19,468 ERCP procedures were performed in three endoscopy units of three hospitals in China. Diagnoses, management, and outcomes were identified and retrospectively reviewed in 58 of these patients. According to the classification system, 58 patients included 8 with type I, 44 with type II, 4 with type III, and 2 with type IV perforation. Of type I perforations, 7 patients underwent endoscopic closure with endoclips, and 1 patient was treated with surgical repair. Of type II perforations, 11 patients were actively managed using the fully covered self-expandable metallic stents (SEMS) to seal the perforation, and 33 patients were passively managed using nose-biliary drainage, in which 13 cases had retroperitoneal abscess formation and were successfully treated by abdominal computed tomography (CT)-guided percutaneous external drainage, but 1 patient died due to sepsis. One patient with type III perforation (pancreatic duct perforation) underwent endoscopic pancreatic duct stent placement after surgery failure. The mean hospital stay of 11 cases with type II perforation treated actively by endoscopy (26.5 ± 3.3 days) was lower compared with 33 cases who received passive conservative treatment (34.6 ± 3.9 days). Many (especially type I and II) ERCP-related duodenal perforations can be successfully treated with endoscopic management. Active endoscopic therapy may be better than passive conservative treatment for type II perforations.

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangio-pancreatography (ERCP) or endoscopic ultrasound (EUS), or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis, and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

在胰腺的疾病的管理的内视镜的治疗的角色连续地正在演变；目前，胰的很病理学的条件成功地被对待由内视镜后退 cholangio-pancreatography (ERCP ) 或内视镜的超声(EUS ) ，或两个。stents 的内视镜的放置在慢性胰炎的处理起了并且仍然玩一个主要作用，假包囊，胰经利和，主要的胰腺的管损害，胰腺的 fistulae，尖锐胰腺炎的复杂并发症，周期性的自发的胰腺炎，并且在 post-ERCP 胰腺炎的预防。这些 stents 习惯性地当前被放减少管内高血压，绕过妨碍石头，与主导的、征兆的苛评在情况中恢复腔明显，封上主要的胰腺的管混乱，排干假包囊或液体集合，对待征兆的主要或次要的乳头状的小突起括约肌狭窄，并且阻止导致过程的尖锐胰腺炎。现在的评论瞄准在胰的急性、长期的煽动性的疾病更新并且讨论内视镜的胰腺的管斯滕特氏印模膏放置的技术，指示，和结果。