Endoscopic Transpapillary Drainage Research Articles

Endoscopic Ultrasound-Guided Pancreaticogastrostomy

In patients with symptomatic dilatation of the pancreatic duct in whom the conventional approach for the placement of an endoscopic transpapillary drainage catheter has been unsuccessful, endoscopic ultrasound (EUS)-guided pancreatic duct drainage (EUPD) has been introduced as an alternative to surgery or a rescue therapy after surgery. Here is demonstrated an EUS-guided pancreaticogastrostomy (EUS-PG) in a patient after acute necrotizing pancreatitis and endoscopic retrograde pancreaticography (ERP) showing a complete rupture of the pancreatic duct behind the head without filling of the duct in the corpus and tail of the pancreas. The dilated pancreatic duct in the corpus and tail of the pancreas looks for a disconnected pancreatic tail syndrome. This article is part of an expert video encyclopedia.

Indications et choix de technique de drainage en cas de pancréatite aiguë grave ?

Definition of severe acute pancreatitis includes organ failure or/and pancreatic or peripancreatic fluid collections. Three types of emergency drainage can be discussed in such a situation: Biliary drainage by early endoscopic sphincterotomy, transpapillary endoscopic drainage in case of early pancreatic fistula, and peripancreatic fluid collections drainage using four different approaches (percutaneous radiologic drainage, retroperitoneal drainage by surgical laparoscopy, transgastric or transduodenal endoscopic drainage and open surgical necrosectomy). The purpose of this mini-review is to focus on the current indications and choices of these different types of drainage approach.

Un pseudokyste médiastinal avec fistule thoracopancréatique traité avec succès par drainage endoscopique transpapillaire

Mediastinal pancreatic pseudocysts are rare but lifethreatening complications of pancreatitis. Rupture and fistulization occur in approximately three percent of cases. The management of mediastinal pseudocysts remains controversial and depends upon the exact location, etiology, ductal anatomy and expertise available. However, endoscopic interventions are increasingly used as the first modality of treatment. Here, we describe a case of mediastinal extension of a pancreatic pseudocyst successfully managed with endoscopic transpapillary drainage.

Multiple Pancreatic Pseudocysts Treated with Endoscopic Transpapillary Drainage

Management of a solitary pancreatic pseudocyst with endoscopic transpapillary stent drainage is a well recognized treatment modality. Endoscopic options are however limited in the presence of multiple pancreatic pseudocysts. Conventionally surgery has been the mainstay of treatment in this situation. In this case report, we present a patient with multiple pancreatic pseudocysts who was successfully treated via transpapillary placement of pancreatic duct stent.

Non-surgical management of pancreatic pseudocysts associated with arterial pseudoaneurysm

BackgroundPseudoaneurysms associated with pancreatic pseudocysts are different from simple, isolated pancreatic pseudoaneurysms and there is paucity of published data on their non surgical treatment. AimTo retrospectively analyze results of combination of angioembolisation or thrombin injection followed by endoscopic transpapillary drainage for management of pseudoaneurysms associated with pancreatic pseudocysts. MethodsEight patients (all males; mean age ± SD: 31.2 ± 6.1 years; age range: 21–38 years) underwent radiological management of the pseudoaneurysm followed by endoscopic drainage of the pseudocysts. ResultsAll patients had pseudocysts (median size 4 cm) with underlying chronic pancreatitis. All patients had abdominal pain on presentation and 7/8 (87.5%) patients had presented with overt gastrointestinal bleeding. The size of the pseudoaneurysms varied from 1 to 4 cm. Two patients were treated with percutaneous thrombin injection whereas six patients underwent digital subtraction angiography and angioembolisation. All patients underwent successful endoscopic transpapillary drainage through the major (5) or minor papilla (3) and resolution of pseudocysts was noted within 6 weeks (median 4 weeks). No significant complication of the procedure was noted in any of the patients. ConclusionsPseudoaneurysms associated with pancreatic pseudocysts can be successfully and safely treated with a combination of radiological obliteration of the pseudoaneurysm followed by endoscopic transpapillary drainage.

Esophageal stricture following successful resolution of a mediastinal pseudocyst by endoscopic transpapillary drainage

Esophageal stricture following successful resolution of a mediastinal pseudocyst by endoscopic transpapillary drainage

VH19 Endoscopic Transpapillary Drainage of an Infected Biloma: A Novel Approach

Bile leaks complicate up to 0.9% of cholecystectomies and may result in a biloma. Traditionally, bilomas are managed by percutaneous drainage or surgery. Successful transenteric EUS guided drainage of bilomas has also been reported. The goal of this video is to illustrate the novel technique of endoscopic transpapillary drainage of a biloma. A 35-year-old male, with a prior h/o cholecyctestomy was admitted with a 3 day history of abdominal pain, jaundice, and high fevers. Abdominal ultrasound revealed a collection in the gallbladder fossa measuring 4.3cm in maximal diameter, with fluid level.

Su1448 How to Treat the Pancreatic Pseudocyst and Abscess - Is Endoscopic Transpapillary Drainage (ENPD and ESP) the Best Treatment? Our Experience of 113 Cases

Su1448 How to Treat the Pancreatic Pseudocyst and Abscess - Is Endoscopic Transpapillary Drainage (ENPD and ESP) the Best Treatment? Our Experience of 113 Cases

Su1379 EUS-Guided Transluminal Drainage of the Pancreatic Duct (EUPD) - Preliminary Results of an Ongoing Systematic Prospective Observational Study Reflecting Daily Clinical Practice

Endoscopic transpapillary drainage has been established as gold standard for the treatment of a retained pancreatic duct in symptomatic patients with chronic pancreatitis. In cases, in wich papilla of Vater (papilla) can not be reached or catheterized or in postinterventional problems (fistula, “Disconnected pancreatic tail syndrome” [DPTS]), EUPD can be a helpful alternative therapeutic option.

Endoscopic transpapillary drainage for external fistulas developing after surgical or radiological pancreatic interventions

External pancreatic fistulas (EPFs) are a therapeutic challenge. The present study was conducted to evaluate the efficacy of endoscopic transpapillary nasopancreatic drainage (NPD) in patients with EPF. Over 12 years, 23 patients (19 males) with EPF underwent attempted endoscopic transpapillary NPD. The end points were fistula closure with healing of pancreatic duct disruption on nasopancreatogram, or need for surgery. All 23 patients had persistent drain output (>50 mL/day) for >6 weeks. The mean output volume of the fistula was 223 mL (range: 60 mL to 750 mL). Sixteen patients had partial and seven patients had complete pancreatic duct disruption. The NPD could be successfully placed in 21/23 (91.3%) patients. Disruption was bridged in 15 of 16 patients with partial duct disruption. EPF healed in 2-8 weeks of placement of NPD in all of the patients with partial duct disruption that was bridged and there was no recurrence at a mean follow-up of 38 months. The EPF resolved in only 2/6 (33%) patients with complete duct disruption. External pancreatic fistulas developing following percutaneous drainage of pancreatic fluid collections or surgical necrosectomy can be effectively treated by transpapillary nasopancreatic drain placement especially when there is partial ductal disruption and the disruption can be bridged.

T1661 Endoscopic Transpapillary Drainage Alone to Treat Large Pancreatic Pseudocysts at Tail Region of Pancreas

T1661 Endoscopic Transpapillary Drainage Alone to Treat Large Pancreatic Pseudocysts at Tail Region of Pancreas

VHM09: EUS-Guided Hepaticogastrostomy With a Transluminal Stent for Proximal Biliary Obstruction After a Failed ERCP

Endoscopic ultrasound(EUS)-guided hepaticogastrostomy may be a useful alternative method for patients with proximal biliary obstruction in whom endoscopic transpapillary biliary drainage failed. This case series was conducted to determine the feasibility and usefulness of EUS-guided hepaticogastrostomy technique for patients with proximal biliary obstruction when the endoscopic transpapillary drainage was unsuccessful.

Endoscopic retrograde pancreatography in pancreatic trauma: Need to break the mental barrier

Pancreatic injury has a high morbidity and mortality. The integrity of the main pancreatic duct is the most important determinant of prognosis. Serum amylase, peritoneal lavage and computed tomography of the abdomen can assist with diagnosis but endoscopic retrograde pancreatography (ERP) is the most accurate investigation for diagnosing the site and extent of ductal disruption. However, it is invasive and can be associated with significant complications. Magnetic resonance cholangiopancreatography (MRCP) and secretin-enhanced MRCP probably parallel ERP in delineating pancreatic ductal injuries. They can also delineate the duct upstream to complete disruption, an area not visualized on ERP. In relation to therapy, endoscopic transpapillary drainage has been successfully used to heal duct disruptions in the early phase of pancreatic trauma and, in the delayed phase, to treat the complications of pancreatic duct injuries such as pseudocysts and pancreatic fistulae. Transpapillary drainage is especially effective in patients who have partial pancreatic duct disruption that can be bridged. Endoscopic transmural drainage has also been successfully used to treat post-traumatic pancreatic pseudocysts. Further large, prospective and randomized studies are required to adjudge the efficacy and long-term safety of pancreatic duct drainage in the treatment of post-traumatic pancreatic duct injuries.

Endoscopic transpapillary drainage of Wirsung's duct in chronic pancreatitis

Endoscopic transpapillary drainage of the main pancreatic duct is a novel, non-surgical method for the treatment of chronic pancreatitis. It seems to be particularly suited for the obstructive form characterized by dilatation of the duct system due to stenoses. Up to now drainages could be successfully performed in five out of six patients. In three cases a divided pancreas was present. The preliminary results are favourable: pain was almost completely eliminated and the patients gained weight. Complications due to the intervention have not been registered as yet. There was no obstruction or dislocation of catheters over an observation period of up to 18 weeks.

Transgastric pancreatography and EUS-guided drainage of the pancreatic duct

Endoscopic transpapillary drainage of the retained pancreatic duct in symptomatic patients with chronic pancreatitis is considered an established treatment option. The aim of this study was to investigate, as an alternative, endoscopic ultrasound (EUS)-guided transgastric pancreatography and drainage of the pancreatic duct, in terms of their feasibility and outcome. All consecutive symptomatic patients with failure of the traditional approach to catheterize and drain the pancreatic duct, over a 3-year time period, were enrolled in this prospective, observational single-center study (case series). Feasibility was characterized by success rate, outcome by complication rate (frequency of bleeding or perforation), mortality, and follow-up. Twelve patients underwent 14 interventions (sex ratio, M/F, 10:4; age range, 43-77 years) from November 2002 to October 2005. The main indication was retention of the pancreatic duct associated with pain, in particular: (i) papilla not reachable because of prior gastrointestinal surgery (n = 5); and (ii) not possible to introduce the catheter through the papilla in chronic pancreatitis or "pancreas divisum" (n = 7). Pancreatography was successful in all patients (normal finding with no therapeutic consequence, n = 1 [after pancreaticojejunostomy]), whereas drainage of the pancreatic duct was achieved in 9 patients (69%; attempts, n = 13). The transgastric route was used in 5 patients and the transpapillary route (rendezvous technique with endoscopic retrograde cholangiopancreatography [ERCP]) in 4. There was a complication rate of 42.9%, comprising postinterventional pain (n = 4; 28.6%); bleeding (n = 1); and perforation because of retriever problems (n = 1). The postinterventional pancreatitis rate was 0% and mortality was 0%. The follow-up investigation (range, 4 weeks - 3 years) revealed that 4 patients (28.6%) subsequently underwent surgical intervention, because of duodenal stenosis (n = 1; 7.1%), suspicious tumor growth (n = 1; 7.1%), and insufficient drainage of the pancreatic duct (n = 2; 14.3%). In 2 subjects (14.3%), endoscopic reinterventions became necessary, which were subsequently successful. There were the following technical problems: 1) Too dense stenosis (n = 3); 2) inadequate equipment (insufficient infeed of the endoscopic tool because of its bending), in each case. Transgastric pancreatography and EUS-guided drainage of the pancreatic duct are reasonable and feasible alternative options for diagnostic and therapeutic management for selected indications (chronic pancreatitis; anomaly of the congenital pancreatic or postoperative gastrointestinal anatomy), with an acceptable periinterventional risk, which broaden the therapeutic spectrum and may avoid surgery but need further evaluation and follow-up investigation.

NASOGALLBLADDER DRAINAGE FOR MIRIZZI’S SYNDROME

The authors experienced a case of Mirizzi’s syndrome successfully treated with endoscopic nasogallbladder drainage (ENGBD). The patient was a 63‐year‐old man. He was admitted with abdominal pain and jaundice. Laboratory data indicated leukocytosis and elevation of serum bilirubin level. Abdominal ultrasound showed marked swelling of gallbladder and debris in the gallbladder, therefore, the authors strongly suspected Mirizzi’s syndrome. He had past history of acute myocardial infarction and treated with anticoagulation therapy. Then, the authors couldn’t perform surgical removal or percutaneous transhepatic drainage, and tried endoscopic transpapillary drainage. Endoscopic retrograde cholangiopancreatography revealed smooth stricture in the superior portion of common bile duct and occlusion of the cystic duct, and ENGBD was then performed. After ENGBD, his complaints, laboratory data, swelling of gallbladder and stricture of common bile duct were all remarkably improved.

Combined Endoscopic Transgastric and Transpapillary Drainage of an Infected Biloma

Combined Endoscopic Transgastric and Transpapillary Drainage of an Infected Biloma

Transgastric Pancreaticography and EUS-Guided Drainage of the Pancreatic Duct

Endoscopic transpapillary drainage of the retained pancreatic duct in symptomatic patients with chronic pancreatitis is considered an established treatment option. The aim of this study was to investigate, as alternative, the EUS-guided transgastric pancreaticography and darainage of the pancreatic duct, in particular, their feasibility and outcome. Patients & Methods: All consecutive symptomatic patients with failure of the traditional approach to catheterize and drain the pancreatic duct through a 3-year time period were enrolled in this prospective observational unicenter study (case series).

Outcomes of surgical and endoscopic transpapillary treatment in patients with pancreatic pseudocysts

Purpose: This study sought to compare outcomes of patients undergoing endoscopic transpapillary drainage for pancreatic pseudocyst with the outcomes of patients undergoing traditional surgical treatment. Methods: Data from patients undergoing treatment for pancreatic pseudocysts over a ten year period were prospectively collected. Analysis of outcomes was performed; correlation between outcome, type of procedure, laboratory values and patient demographics was sought. Chi square test, Fisher Exact Probability Test and Student’s t-test were used for statistical analysis. Results: From June 1993 to December 2004, 69 patients with pancreatic pseudocysts were treated, 43 surgically and 26 with endoscopic transpapillary drainage as patients were referred. About 60% of treatments were performed urgently. Surgical treatments consisted of cystgastrostomy (32 %), distal pancreatectomy (27%), and cystjejunostomy (25%). Attempted ERCP drainage failed in 4 of 26 patients (15%), two of which underwent surgical treatment. Recurrence of pseudocysts occurred in two patients (2/69, 2%), one surgical and one endoscopic. Of the patients who underwent successful ERCP, initial resolution was achieved in 18 of 20 patients (90%); two patients have incomplete follow-up. Mean follow up was 62 months. Comparing endoscopic treatment and surgical treatment the surgery group was slightly older (36 vs 41 yrs, p<0.01), had a slightly higher ASA (2.5 vs 2.7, p <0.01), a similar distribution of men and women (61% and 65% men respectively), and a larger pseudocyst (6 vs 9cm diameter, p<0.01). Complications were less frequent with the endoscopic approach (11% vs 48%, p < 0.001). An ASA classification of 3 (15/25, 60%) or 4 (2/2, 100%) was significantly associated with the development of post-operative complications (p<0.05) in surgical patients. Other variables measured included pseudocyst size and laboratory values, none of which were found to be significantly associated with postoperative complications. Conclusions: Successful resolution of pancreatic pseudocysts can be achieved by transpapillary drainage and surgical treatment. In this study with not entirely congruent study groups ERCP appeared associated with fewer complications than conventional surgical treatment. Patient variables, specifically ASA classification, may guide surgeons towards a choice of treatment.

Intrasplenic pancreatic abscess successfully treated by endoscopic transpapillary drainage through the minor papilla

Intrasplenic pancreatic pseudocyst and abscess are rare complications of chronic pancreatitis, and conventional treatment is surgery.1-7 Based on our literature search, we could find no published reports on the endoscopic management of intrasplenic pancreatic abscess. We report a 35-year-old alcoholic man with chronic calcific pancreatitis, complete pancreas divisum, and intrasplenic pancreatic abscess, successfully managed by nasopancreatic drainage through the minor papilla followed by minor papilla sphincterotomy and stent placement.