The role of transpapillary drainage in management of patients with pancreatic fluid collections and pancreatic duct disruption as a consequences of severe acute pancreatitis

ABSTRACTPancreatic fluid collections are usually peripancreatic in location but can be found at various atypical locations such as the mediastinum. Mediastinal pseudocysts are very rare and are very unusual cause of dysphagia. Here, we report a rare case of mediastinal pseudocyst occuring because of pancreatic duct disruption due to chronic pancreatitis and presenting as dysphagia and successfully treated with endoscopic transpapillary stent placement.

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Management of severe acute pancreatitis

BMJ ◽

10.1136/bmj.l6227 ◽

2019 ◽

pp. l6227 ◽

Cited By ~ 10

Author(s):

O Joe Hines ◽

Stephen J Pandol

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Best Practice ◽

Pancreatic Pseudocysts ◽

Good Survival ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Performance Development ◽

Fluid Collections ◽

Pancreatic Complications

ABSTRACT The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques. Surgery is no longer an early intervention and may not be needed. Instead, interventional radiologic and endoscopic methods seem to be safer with at least as good survival outcomes. Newly developed evidence based quality indicators are available to assess and improve performance. Development and clinical testing of drugs to target the mechanisms of disease are necessary for further advancements.

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M1475: The Necessity of Pancreatic Duct Visualization in the Treatment of Pancreatic Fluid Collections Complicating Acute Pancreatitis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2010.03.475 ◽

2010 ◽

Vol 71 (5) ◽

pp. AB231 ◽

Cited By ~ 1

Author(s):

Erienne M. De Cuba ◽

Rogier P. Voermans ◽

Erik Rauws ◽

Paul Fockens

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections

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The Role of Endoscopic Transpapillary Stenting of the Main Pancreatic Duct during the Endoscopic Treatment of Pancreatic Fluid Collections

Journal of Clinical Medicine ◽

10.3390/jcm10040761 ◽

2021 ◽

Vol 10 (4) ◽

pp. 761

Author(s):

Mateusz Jagielski ◽

Marek Jackowski

Keyword(s):

Pancreatic Duct ◽

Endoscopic Treatment ◽

Main Pancreatic Duct ◽

Pancreatic Necrosis ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Pancreatic Fluid ◽

Transpapillary Drainage ◽

Fluid Collections

Endotherapy is a recognized, widely available, and minimally invasive treatment method for pancreatic fluid collections (PFCs) formed in the course of acute pancreatitis (AP). The use of endoscopic techniques in the treatment of main pancreatic duct (MPD) disruption due to AP remains unclear. In this article, a comprehensive review of current literature referencing our observations was performed to identify publications on the role of MPD stenting in patients undergoing endoscopic drainage of PFCs resulting from AP. In this paper, we attempt to clarify this most controversial aspect of endotherapy for PFCs based on existing knowledge and our own experience regarding the endoscopic treatment of AP sequelae. Endoscopic retrograde pancreatography should be performed in all patients undergoing endoscopic drainage of walled-off pancreatic necrosis to assess the integrity of the main pancreatic duct and to implement endotherapy if pancreatic duct disruption is detected. Passive transpapillary drainage is an effective method for treating MPD disruption in the course of necrotizing AP and is one of the key components of endoscopic therapy for local pancreatic necrosis. Conversely, in patients with pancreatic pseudocysts, passive transpapillary drainage reduces the effectiveness of endoscopic treatment and should not be used even in cases of MPD disruption during transmural drainage of pancreatic pseudocysts. In conclusion, the use of transpapillary drainage should depend on the type of the PFC. This conclusion is of great clinical importance, as it can help improve the results of pancreatic endotherapy for fluid collections resulting from AP.

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Endoscopic nasopancreatic duct drainage for the treatment of severe acute pancreatitis with pancreatic duct disruption: a case report

Suizo ◽

10.2958/suizo.26.719 ◽

2011 ◽

Vol 26 (6) ◽

pp. 719-724

Author(s):

Kenichi MATSUYA ◽

Masataka KIKUYAMA ◽

Takafumi KUROKAMI

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Pancreatic Duct ◽

Severe Acute Pancreatitis ◽

Pancreatic Duct Disruption ◽

Duct Disruption

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Diagnosis of pancreatic duct disruption in acute pancreatitis

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/10.16931/1995-5464.2021-2-15-24 ◽

2021 ◽

Vol 26 (2) ◽

pp. 15-24

Author(s):

T. G. Dyuzheva ◽

A. V. Shefer ◽

E. V. Dzhus ◽

M. V. Tokarev ◽

A. P. Stepanchenko ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Pancreatic Duct Disruption ◽

Duct Disruption

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Management of Pancreatic Fluid Collections: A Changing of the Guard from Surgery to Endoscopy

The American Surgeon ◽

10.1177/000313481107701237 ◽

2011 ◽

Vol 77 (12) ◽

pp. 1650-1655 ◽

Cited By ~ 7

Author(s):

Shyam Varadarajulu ◽

C. Mel Wilcox ◽

Sahibzada Latif ◽

Milind Phadnis ◽

John D. Christein

Keyword(s):

Practice Patterns ◽

Treated Group ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Group I ◽

Impacting Factors ◽

Transmural Drainage ◽

Group Ii ◽

Fluid Collections

The aim of this study was to assess for any trend in management of pancreatic fluid collections (PFCs) and identify impacting factors. The endoscopy and surgical databases were queried for PFC patients. PFCs were categorized as pseudocysts (PP) or complex collections (CC) that included abscess/necrosis. The outcome measures were to compare the utilization of surgery and endoscopy from 2004 to 2007 (group I) and from 2008 to 2010 (group II) and identify factors impacting practice patterns. A total of 285 patients were treated: group I included 119 and group II 166. Of 119 group I patients, 29 per cent were treated by surgery and 71 per cent by endoscopy. Of 85 endoscopy patients, 42 per cent were drained by conventional transmural drainage and 58 per cent by endoscopic ultrasound (EUS). Of 166 group II patients, 31 per cent were treated surgically and 69 per cent endoscopically. Of the 115 endoscopy patients, 17 per cent were drained by conventional transmural drainage and 83 per cent by EUS. Compared with group I, all pseudocysts in group II were treated by endoscopy (84% vs 100%, P = 0.001). There was no difference in the rate of CC treated by endoscopy between both groups (57.7% vs 56.8%, P = 0.9). PFCs not causing luminal compression ( P < 0.0001) or measuring <9 cm in size ( P < 0.0001) were more likely to require EUS. There was a significant trend at our institution in the management of PFCs with all pseudocysts presently being treated only by endoscopy. The ability of EUS to access smaller size PFCs and those not causing luminal compression has significantly expanded the role of endoscopy in PFC management.

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