ID: 3525066 COMBINATION OF RECTAL INDOMETHACIN AND PANCREATIC DUCT STENTING IS SUPERIOR TO INDOMETHACIN ALONE IN PREVENTING POST-ERCP PANCREATITIS ONLY IN PATIENTS UNDERGOING DOUBLE WIRE CANNULATION

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

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Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101380 ◽

2020 ◽

pp. flgastro-2019-101380

Author(s):

Jared Rejeski ◽

Marc Hines ◽

Jason Jones ◽

Jason Conway ◽

Girish Mishra ◽

...

Keyword(s):

High Volume ◽

Complication Rates ◽

Success Rates ◽

Biliary Cannulation ◽

Pancreatic Duct Stenting ◽

Significant Difference ◽

Effective Option ◽

Needle Knife ◽

Precut Sphincterotomy ◽

Rectal Indomethacin

GoalsOur study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.BackgroundComplication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.StudyWe performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.ResultsWe identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).ConclusionThis data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

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Narcotic Independence After Pancreatic Duct Stenting Predicts Narcotic Independence After Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Pancreas ◽

10.1097/mpa.0000000000000623 ◽

2016 ◽

Vol 45 (8) ◽

pp. 1126-1130 ◽

Cited By ~ 6

Author(s):

Richard S. Kwon ◽

Benjamin E. Young ◽

William F. Marsteller ◽

Christopher Lawrence ◽

Bechien U. Wu ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Lateral Pancreaticojejunostomy ◽

Pancreatic Duct Stenting

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Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.11.022 ◽

2015 ◽

Vol 81 (6) ◽

pp. 1408-1416 ◽

Cited By ~ 30

Author(s):

David M. Troendle ◽

Omana Abraham ◽

Rong Huang ◽

Bradley A. Barth

Keyword(s):

Pancreatic Duct ◽

Pediatric Population ◽

Factors Associated ◽

Pancreatic Duct Stenting

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Pancreatic duct stenting in the treatment of acute pancreatitis

Khirurgiya Zhurnal im N I Pirogova ◽

10.17116/hirurgia201909113 ◽

2019 ◽

pp. 13 ◽

Cited By ~ 1

Author(s):

V. V. Mozharovsky ◽

A. G. Mutnykh ◽

I. N. Zhukov ◽

K. V. Mozharovsky

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Duct Stenting

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Early removal of biflanged metal stents in the management of pancreatic walled-off necrosis: a prospective study

Endoscopy ◽

10.1055/s-0043-123575 ◽

2017 ◽

Vol 50 (06) ◽

pp. 597-605 ◽

Cited By ~ 12

Author(s):

Vinay Dhir ◽

Douglas Adler ◽

Ankit Dalal ◽

Nitin Aherrao ◽

Rahul Shah ◽

...

Keyword(s):

Adverse Events ◽

Pancreatic Duct ◽

Recurrence Rate ◽

Plastic Stents ◽

Metal Stents ◽

Plastic Stent ◽

Early Removal ◽

Pancreatic Duct Stenting ◽

Walled Off Necrosis

Abstract Background and study aims Dedicated stents placed under endoscopic ultrasound (EUS) guidance have shown promise for the management of pancreatic walled-off necrosis (WON). A long duration of stent placement may increase the risk of adverse events. We prospectively evaluated the effects of (i) early removal of biflanged metal stents (BFMSs) and (ii) additional stenting of the pancreatic duct with plastic stents in patients with ductal leaks, on the risk of WON recurrence. Patients and methods Symptomatic patients with pancreatic WON underwent EUS-guided BFMS placement, followed by necrosectomy, when required, from Day 3. A 5 Fr plastic stent was placed in patients with ductal leak. BFMS was removed when the WON cavity had collapsed completely. Patients were followed up at 3-month intervals. Results BFMS placement was successful in all 88 patients. A total of 64 patients (72.7 %) underwent necrosectomy (median 3 sessions). All BFMSs were removed at a median of 3.5 weeks (range 3 – 17 weeks). Ductal disconnection and leak occurred in 53/87 (60.9 %) and 61/87 (70.1 %) patients, respectively. A 5 Fr stent was placed in 56/61 patients (91.8 %) with ductal leak. Overall, 22 patients (25.0 %) had adverse events (17 mild, 1 moderate, 3 severe, 1 fatal). Recurrence was noted in 8/88 (9.1 %) at a median follow-up of 22 months. The recurrence rate was higher in patients with ductal disconnection than in those without (13.2 % vs. 2.9 %; P = 0.08), and was similar in patients with vs. without pancreatic duct stenting (7.1 % vs. 12.9 %; P = 0.44). Seven recurrences (87.5 %) partially regressed on follow-up and did not require therapy; in one case, drainage with a plastic stent was performed. Conclusions Short-term BFMS placement is an effective therapy for pancreatic WON. The majority of recurrences developed in patients with ductal disconnection and did not require therapy. Additional pancreatic duct stents probably do not influence the recurrence rate.

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