Pancreatic Duct Leak Research Articles

976 SEALING THE LEAKING PANCREATIC DUCT WITH ENDO PROSTHESIS IN FAILED ERCP

Pancreatic Duct (PD) leak leading to pancreatic ascites is a serious complication of chronic pancreatitis. Endoscopic management has been found to be feasible and safe in these patients and includes Endoscopic Retrograde Cholangio Pancreaticography (ERCP) with selective cannulation of the pancreatic duct and trans-papillary drainage by a pancreatic sphincterotomy followed by stent placement ideally bridging the location of the leak. Endoscopic ultrasound (EUS) guided rendezvous procedures are a promising alternative in patients who have a failed ERCP. A dilated Pancreatic duct(PD) is ideal for a successful EUS guided rendezvous procedure. Till date, EUS guided rendezvous procedures have not been reported for patients with pancreatic ascites. We report a modified EUS guided rendezvous technique which was successfully performed to treat a patient with pancreatic ascites especially in the setting of a non-dilated PD. In this patient, ERCP was unsuccessful and he was a high risk surgical candidate. Case details 64 year old male from Kerala , India Clinical history: Intermittent abdominal pain and progressive abdominal distension. Past medical history: No other significant illnesses. History of alcohol abuse for more than 30 years. Relevant Laboratory studies showed: Hemoglobin: 13.5 g/dl. Platelet count: 522,000/ μL. Serum Bilirubin: 0.42 mg/dl. Serum Albumin: 2.78 g/dl. INR: 1.12. Ascitic fluid analysis: Total protein: 3.6 g/dL. Cell count: 200 cells/ mm3. Amylase: 20,000 U/L. CT Abdomen: Atrophic pancreas with parenchymal calcifications and gross ascites. MRI-MRCP: Non dilated pancreatic duct. No strictures. Suspicious leak from the neck of the pancreas. An ERCP was attempted but neither major nor minor papilla could be cannulated. The video demonstrates a Modified EUS guided rendezvous procedure which was successfully performed in this patient with pancreatic ascites and a non-dilated PD which can be viable alternative for patients with a failed ERCP.

Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation

BackgroundPancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak.Case presentationWe describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution.ConclusionPancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.

Endoscopic Ultrasound-Guided Rendezvous Procedure for a Nondilated, Leaking Pancreatic Duct

Pancreatic duct (PD) leak leading to pancreatic ascites is a serious complication of chronic pancreatitis. Endoscopic management with endoscopic retrograde cholangiopancreatography (ERCP) has been found to be successful; however, if selective cannulation of the PD is unsuccessful, an endoscopic ultrasound-guided rendezvous procedure can help in bridging PD leaks, provided the duct is dilated. We report a successful endoscopic ultrasound-guided rendezvous procedure in a patient with PD leak, pancreatic ascites, and a nondilated duct with failed ERCP who was a poor candidate for surgery. The pancreatic ascites resolved following the procedure.

Laparoscopic surgery for solitary insulinoma in the absence of IOUS.

Background:Insulinomas are the most common pancreatic neuroendocrine neoplasms. In spite of adequate pre-operative localisation, conventional surgical methods rely on intraoperative palpation. Intraoperative ultrasonography (IOUS) is said to aid in accurate localisation, decreases morbidity. Laparoscopic removal of pancreatic endocrine neoplasms is beneficial due to magnification and minimal invasion; however, in the absence of IOUS, error of judgement may lead to conversion to open surgery, thereby relying on ‘palpation method’ to localise the tumour. We combined laparoscopic surgical removal of insulinomas using an innovative method of ‘laparoscopic finger palpation’ with intraoperative blood glucose monitoring and frozen section for surgical cure.Materials and Methods:Patients were evaluated and investigated by the department of endocrinology and referred for surgical management of insulinoma. Pre-operative localisation of insulinoma was done by either contrast-enhanced computerised tomography angiogram – arterial and venous phase, or endoscopic ultrasound (EUS) or DOTATATE scan. Intraoperative localisation was done by laparoscopic dissection and ‘laparoscopic finger palpation’. After enucleation, the specimen was sent for frozen section, and in the interim period, serial monitoring of blood glucose was done by the anaesthetist. Maintenance of glucose levels for more than 45 min after enucleation and confirmation of neuroendocrine tumour on frozen section was the end point of surgical procedure.Results:A total of 19 patients were subjected to laparoscopic removal of solitary insulinomas. Enucleation was performed in 16 patients successfully. In three patients, laparoscopic distal pancreatectomy was performed. Three patients had pancreatic duct leak, of which two patients responded to conservative approach and the third patient required drainage by USG-guided pigtail catheter. All patients are cured of their disease and no patient has had recurrence so far.Conclusion:Multidisciplinary approach involving laparoscopic palpation, frozen sections and intraoperative blood sugar monitoring helps laparoscopic management of solitary insulinomas without IOUS.

Treatment of Walled-off Pancreatic Necrosis by Percutaneous Endoscopic Necrosectomy

Walled-off pancreatic necrosis (WOPN) consists of a mature collection of pancreatic necrotic tissue within a well-defined inflammatory wall. Treatment involves drainage and debridement of the necrotic material. Modalities such as laparoscopic, endoscopic, and video-assisted retroperitoneal debridement are effective, and have less morbidity than open surgery. Percutaneous endoscopic necrosectomy (PEN) is a novel technique that allows the operator to use conventional endoscopes to perform necrosectomy via a percutaneous tract in patients with WOPN that is difficult to access via the stomach or duodenum. A 44-year old male with newly diagnosed diabetes mellitus presented with severe abdominal pain and sepsis secondary to a peripancreatic fluid collection that developed after an episode of acute pancreatitis. On arrival, his vitals were: Temp 100.4 F, BP 100/63 mm Hg, HR 129 beats/min, RR 20 breaths/min, and SPO2 96% room air. Abdominal examination revealed mild distension and severe epigastric tenderness. A percutaneous drain was placed via the left flank into the fluid collection at another facility. However, the collection persisted and grew E. Coli and K. Pneumoniae. Endoscopic ultrasound showed a debris-filled cavity abutting the pancreatic tail without close approximation to the gastric wall. Following upsizing of the percutaneous drain, three sessions of PEN were performed via the drain tract. Ongoing drainage was found to originate from a colonic fistula and pancreatic duct leak, which were treated with a diverting loop colostomy and endoscopic retrograde cholangiopancreatogram (ERCP) with pancreatic duct stent placement, respectively. The patient's condition improved with and resolution of the duct leak, confirmed on repeat ERCP performed two months later. His percutaneous drainage eventually stopped and the external drain was removed. PEN is a safe and effective minimally invasive technique that can be used to treat WOPN. It may be the procedure of choice in instances where necrosis cannot be accessed through the stomach or duodenum. Recent studies have shown that PEN has superior safety profile compared to the existing endoscopic (e.g. transgastric endoscopic necrosectomy) or surgical interventions. Additionally, percutaneous access along a predefined tract avoids inherent complexities of the transluminal approach. This novel technique may also be utilized for other intra-abdominal fluid collection accessible to interventional radiologists.

Conservative Management of a Large, Symptomatic Pancreatic Cyst in a Community Hospital

Pancreatic cysts (PC) are increasingly treated using new endoscopic approaches; however, these techniques are not always readily available and may not always be necessary. Our case describes management of a large PC in a community hospital setting with relatively minimal intervention. A 49-year-old woman with a history of type 2 diabetes presented to a community hospital with epigastric pain. She was diagnosed with pancreatitis, with CT evidence of pancreatic necrosis. Her initial hospital course was complicated by respiratory failure and sepsis, which was ultimately managed conservatively at a tertiary center. Two weeks after her initial presentation, she was re-admitted with recurrent fever, abdominal pain and distension. CT revealed findings consistent with a pseudocyst. Due to persistent fever and pain, repeat imaging was done 3 days later which showed that the cyst had increased from 10cm to 15cm. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, which confirmed a disrupted pancreatic duct (PD). A 5 fr, 5cm PD stent was placed. The patient initially improved, but again presented with fever, abdominal pain and poor intake by mouth. A repeat CT showed that the cyst had enlarged to 20cm with compression of the stomach. Repeat ERCP was performed, persistent PD leak was confirmed, and a 5fr, 9cm PD stent was placed. She required support with parenteral nutrition and antimicrobials, but was discharged to home several weeks later in stable condition, tolerating a regular diet. Repeat CT done prior to discharge confirmed that the cyst had decreased to 13cm. The stent was removed 6 weeks later. At six-month follow-up, she was doing well and imaging showed complete resolution. Patients with asymptomatic PC can be managed conservatively. Management of symptomatic PC usually requires surgical, percutaneous, or endoscopic intervention. Endoscopic intervention has become first line intervention for PC. The use of cyst gastrostomy has been widely publicized, but use is generally limited to tertiary centers. Moreover, many community hospitals are unwilling to manage complicated pancreatic disease, due in part to concerns about the inability to intervene endoscopically, radiographically or surgically if indicated. Despite a concerning and complicated course, our patient was managed successfully at a community hospital with supportive care and a relatively conservative intervention - PD stent placement - that is generally available.Figure: CT Abdomen After Initial Stent Placement: Cyst at its largest size, 20cm, with compression of stomach.Figure: CT Abdomen Prior to Discharge: Improved size of cyst after 9cm stent placement.

Metallic coil and N-butyl-2-cyanoacrylate for closure of pancreatic duct leak (with video)

Pancreatic fistula is a challenging yet common adverse event of partial pancreatectomy. Our objective is to determine the feasibility of endoscopic closure of a pancreatic fistula using a combination of a metallic coil and N-butyl-2-cyanoacrylate (NBCA) glue. A patient with a postoperative pancreatic stump leak recalcitrant to conservative management and pancreatic duct stent placement underwent endoscopic/fluoroscopic placement of a metallic coil in the pancreatic duct followed by injection of .5 mL NBCA and lipiodol mixture directed at the coil. The patient's clinical condition, Jackson-Pratt (JP) drain output, and pancreatic enzyme content were monitored daily after the procedure. The patient's clinical condition improved. JP drain output and amylase/lipase levels progressively decreased to resolution within 7 days of the procedure. No adverse events occurred as a result of the procedure. Endoscopic closure of pancreatic fistula with a metallic coil and NBCA glue is feasible and may be a useful modality for treatment of refractory postpancreatectomy-related fistula.

Endoscopic Management of Biliary Leaks and Pancreatic Duct Leaks After Blunt and Penetrating Abdominal Trauma

Introduction: Bile duct (BD) and pancreatic duct (PD) leaks following traumatic abdominal injury can result in significant morbidity and mortality. Data on endoscopic management of traumatic biliopancreatic leaks with endoprosthesis placement is limited. We sought to evaluate the efficacy and safety of endoscopic stent placement and to determine risk factors that predict failure. Methods: Consecutive patients who underwent ERCP for management of BD and PD leaks following abdominal trauma between 2009-2015 were retrospectively identified. Treatment success was defined as resolution of leak at follow-up ERCP without need for further surgical or percutaneous intervention. Results: 26 patients were included. Median age was 31.5 years (interquartile range (IQR)=23-39.75) with male predominance (n=22; 84.6%). Among 17 patients with bile leaks, median grade of liver injury was 4 (IQR 4-5). Gunshot wound (GSW) was the most common etiology for bile leaks (n=8/17; 47%). Median time from onset of trauma to ERCP was 10 days (IQR 7-16). Resolution of bile leak was achieved in 82.3 % (14/17) following placement of a plastic endoprosthesis; all cases involved injury to right or left intrahepatic ductal system. Three cases (17.6%) were categorized as endoscopic treatment failures, with sites of injury involving the extrahepatic bile duct (n=2) and right hepatic duct (n=1). There was no relationship of treatment outcome to etiology of trauma, grade of liver injury, or prior surgical intervention. Regarding PD leaks, etiologies were penetrating (n=4; 44.4%) or blunt trauma (n=5; 55.5%). Median time from trauma to ERCP was 4 days (IQR=2-9). 77.7% (7/9) of PD leaks were successfully treated with plastic stents (5-7 French). Overall, there were no adverse events related to ERCP and median time to asymptomatic clinic follow-up was 114 days. Conclusion: Endoscopic treatment of traumatic BD and PD leaks offers a high likelihood of technical and clinical success with a low risk of adverse events. ERCP should be considered first-line for treatment of traumatic biliary and pancreatic duct leaks. Large retrospective studies are needed to identify predictors of outcomes following endoscopic therapy.

Black Ascites: An Interesting Presentation of Pancreatic Duct Leak

Black Ascites: An Interesting Presentation of Pancreatic Duct Leak

Black Ascites: An interesting presentation of pancreatic duct leak

Introduction: Common causes of ascites include liver cirrhosis, heart failure, and malignancy. Pancreatic etiology is lesscommon for ascites, but is most often a result of chronic pancreatitis secondary to alcoholic liver damage or pancreatic duct leak.Case description: The following case describes a patient with black-colored ascites secondary to pancreatic duct leak after totalcolectomy with ileorectal anastomosis. The colectomy was indicated by MYH-positive polyposis, and the there was no knownprior liver or pancreas disease. Management included pancreatic duct stent placement, and drains from the pancreatic tail.Discussion: Pancreatic etiology is rare among ascites diagnoses; this case is even rarer due to gross appearance of the asciticfluid and its iatrogenic cause.

Endotherapy is effective for pancreatic ductal disruption: A dual center experience.

Pancreatic duct (PD) disruptions occur as a result of different etiologies and can be managed medically, endoscopically, or surgically. The aim of this study was to provide an evaluation on the efficacy of endotherapy for treatment of PD disruption in a large cohort of patients and identify factors that predict successful treatment outcome. We retrospectively evaluated consecutive patients who underwent endoscopic retrograde pancreatography (ERP) for transpapillary pancreatic stent placement for PD disruption from 2008 to 2013 at two tertiary referral institutions. PD disruption was defined as extravasation of contrast from the pancreatic duct as seen on ERP. Therapeutic success was defined by resolution of PD leak on ERP, clinical, and/or imaging evaluation. We evaluated 107 patients (58% male, mean age 53 years) with PD disruption. Etiologies of PD disruption were acute pancreatitis (36%), post-operative (31%), chronic pancreatitis (29%), and trauma (4%). PD disruption was successfully bridged by a stent in 45 (44%) patients. Two patients developed post-sphincterotomy bleeding, two had stent migration, and two patients died as a result of post-ERP related complications. Placement of a PD stent was successful in 103/107 (96%) patients. Therapeutic success was achieved in 80/107 (75%) patients. Non-acute pancreatitis etiologies and absence of complete duct disruption were independent predictors of therapeutic success. Endoscopic therapy using a transpapillary stent for PD disruption is safe and effective. Absence of complete duct disruption and non-AP etiologies determine a favorable endoscopic outcome.

Management of acute hemorrhagic pancreatitis after EUS-guided FNA of a pancreatic cyst

An asymptomatic 72-year-old woman underwent EUS-guided FNA of an incidental side-branch intraductal papillary mucinous neoplasm (SB-IPMN) in the head of the pancreas at an outside facility. Forty-eight hours after the procedure, she presented to our institution with severe epigastric pain, fever, jaundice, leukocytosis, and elevated lipase consistent with acute pancreatitis. CT of the abdomen andpelvis with contrast medium showed multiple peripancreatic fluid collections (PFC) around the pancreatic head. EUS showed a large PFC in the head region compressing the distal common bile duct (Fig. 1) and a pancreatic duct leak in the neck region. Because the PFC was causing obstructive jaundice, it was aspirated, revealing hemorrhagic fluid. ERCP was then performed to evaluate the pancreatic duct. A leak from a side branch in the head region was demonstrated on pancreatogram, which was bridged with a 4F 10-cm stent (Video 1, available online at www.giejournal.org). The patient also underwent jejunal feeding for 4 weeks through a nasojejunal tube, with resultant clinical improvement and resolution of the PFC on follow-up CT at 30 days. The risk of acute pancreatitis after EUS-FNA of pancreatic lesions is highest with SB-IPMN at 8%. Despite the lack of data, the use of indomethacin before EUS-FNA for pancreatitis prophylaxis can be considered in high-risk patients.

Pancreaticopleural Fistula as a Complication of Chronic Pancreatitis

Chronic pancreatitis and pleural effusions are common conditions encountered by clinicians. We present a case of pancreaticopleural fistula that reminds the clinician to consider a pancreatic source of a new pleural effusion in a patient with known chronic pancreatitis. A 64 year old male with a history of chronic alcoholic pancreatitis presented to the emergency department for shortness of breath and left sided chest pain of a few days duration. Chest x-ray showed a new left side pleural effusion. His dyspnea improved after removal of 2L of fluid, but his pleural effusion rapidly re-accumulated. Pleural fluid was exudative with lipase of 10539 U/L and amylase of 16674 U/L. Magnetic resonance cholangiopancreatography (MRCP) revealed a mid-pancreatic duct stricture and possible fistulous tract to the left pleural space. The patient was started on octreotide and placed on total parental nutrition (TPN). He subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP) which confirmed a mid-pancreatic duct stricture with a fistula arising in the body of the pancreas. A pancreatic sphincterotomy was performed and a pancreatic duct stent was placed. He also underwent video assisted thoracoscopic surgery (VATS) with decortication of the organized left pleural effusion. In spite of this, patient developed a Vancomycin resistant enterococcus (VRE) empyema on the decorticated side, which was treated with chest tube drainage and antibiotics. He recovered completely over a course of 6 weeks. After serial pancreatic duct stenting for 6 months the pancreatic stent was removed and a pancreatogram showed persistent mid-pancreatic duct stricture without evidence of pancreatic duct leak. Pancreaticopleural fistula is a rare complication of chronic pancreatitis most commonly presenting with dyspnea and chest pain. Abdominal symptoms are often not present. Pleural fluid usually tends to be exudative and amylase or lipase analysis is necessary to make the diagnosis. Imaging such as MRCP or ERCP is required to identify a pancreatic duct disruption and or stricture. Treatment can include Octreotide, parental nutrition, and supportive care. ERCP with subsequent endotherapy for stricture is often required. Surgery is usually reserved for those cases not responsive to medical or endoscopic therapies. A multi-disciplinary approach is required in caring for these complicated patients.Figure 1Figure 2Figure 3

EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients

EUS-guided pseudocyst drainage with fully covered self-expandable metal stents (FCSEMSs) was recently described. The appropriate period for stent removal is not known. To assess the safety and efficacy of EUS-guided FCSEMS placement for 3 weeks, along with pancreatic ductal stenting in selected patients. Prospective, single-center evaluation. Tertiary referral center. Symptomatic pseudocysts in the body and tail region of the pancreas. EUS-guided transgastric placement of FCSEMS. MRCP was performed after 3 weeks. Patients with a suspected pancreatic duct leak underwent ERCP and plastic stent placement. The FCSEMSs were removed at 3 weeks. Success of FCSEMS placement, adverse events, and recurrence rate. Forty-seven patients met the eligibility criteria. Technical and functional success was achieved in 43 patients (intention to treat, 91.48% and 95.34% patients [per protocol, 41/43, respectively]). Adverse events occurred in 2 patients (cyst infections, 4.6%). Follow-up of 42 patients at 3 weeks was performed. MRCP detected a ductal leak in 3 patients (7.1%) and a disconnected duct in 2 patients (4.7%). ERCP and stenting were successful in all 3 patients with a ductal leak. During a median follow-up of 306 days in 42 patients, 2 recurrences (4.7%) were detected, both in patients with disconnected duct. Multivariate analysis showed that pancreatic ductal leak or disconnection was an independent factor affecting pseudocyst resolution at 3 weeks (P = .0001). Single-center study. Short-term placement of FCSEMSs with pancreatic ductal stenting in selected patients appears safe and effective for the treatment of pseudocysts.

Endoscopy in the Early Postoperative Setting after Primary Gastrointestinal Anastomosis

IntroductionGastrointestinal anastomoses may require early evaluation and treatment via flexible endoscopic techniques when complications arise. There is reticence, however, to perform endoscopy given the applied mechanical forces. We aimed to identify the incidence of gastrointestinal anastomotic perforation or disruption resulting from endoscopy performed ≤6 weeks of anastomoses. MethodsReview of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate. ResultsTwenty-four patients met our criteria (age 69 years [IQR 54–77], 54 % men]). Endoscopy was performed at a median postoperative time of 18 days (IQR 8–30). Indications for endoscopy included bleeding (66 %), obstruction (13 %), pain (13 %), concern for pancreatic duct leak (4 %), and concern for ischemia (4 %). Six patients underwent therapeutic endoscopic procedures including coagulation (8 %), balloon dilation (8 %), tube decompression (8 %), and stent placement (4 %). There were no anastomotic perforations or disruptions as a result of endoscopy. ConclusionDespite theoretical risks of adverse events of flexible endoscopy in the early postoperative period, no endoscopic perforations or disruptions occurred in recently created surgical anastomoses.

Endoscopic Ultrasound-Guided Transesophageal Drainage of a Mediastinal Pancreatic Pseudocyst

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Single-session, transgastric ERCP using sutured gastropexy for treatment of pancreatic duct leak in a patient with Roux-en-Y gastric bypass anatomy and pancreatic divisum

Single-session, transgastric ERCP using sutured gastropexy for treatment of pancreatic duct leak in a patient with Roux-en-Y gastric bypass anatomy and pancreatic divisum

Management of pancreatic ductal leaks and fistulae

Pancreatic duct leaks can occur as a result of both acute and chronic pancreatitis or in the setting of pancreatic trauma. Manifestations of leaks include pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome, and internal and external pancreatic fistulas. Patient presentations are highly variable and range from asymptomatic pancreatic cysts to patients with severe abdominal pain and sepsis from infected fluid collections. The diagnosis can often be made by high-quality cross-sectional imaging or during endoscopic retrograde cholangiopancreatography (ERCP). Because of their complexity, pancreatic leak patients are best managed by a multidisciplinary team comprised of therapeutic endoscopists, interventional radiologists, and surgeons in the field of pancreatic interventions. Minor leaks will often resolve with conservative management while severe leaks will frequently require interventions. Endoscopic treatments for pancreatic duct leaks have replaced surgical interventions in many situations. Interventional radiologists also have the ability to offer therapeutic interventions for many leak patients. The mainstay of endotherapy for pancreatic leaks is transpapillary pancreatic duct stenting with a stent that bridges the leak if possible, but varies based on the manifestation and clinical presentation. Fluid collections that result from leaks, such as pseudocysts, can often be treated by endoscopic transluminal drainage with or without endoscopic ultrasound or by percutaneous drainage. Endoscopic interventions have been shown to be effective and have an acceptable complication rate.

Su1713 Endoscopic Therapy in Chronic Pancreatitis: What Are the Factors Associated With Successful Response ?

Su1713 Endoscopic Therapy in Chronic Pancreatitis: What Are the Factors Associated With Successful Response ?

Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: Adverse events and avoiding them.

Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and its ability to acquire tissue outside of the gastrointestinal lumen impart risks that are not associated with routine endoscopic procedures. In this review, we discuss the risk of perforation related to the echoendoscope itself and adverse events related to FNA of solid masses including infections, bleeding, pancreatitis and pancreatic duct leak, bile duct leak and tumor seeding. We also provide tips on how to avoid the most common adverse events related to EUS-FNA.