scholarly journals Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

2018 ◽  
Vol 06 (12) ◽  
pp. E1398-E1405 ◽  
Author(s):  
Tanyaporn Chantarojanasiri ◽  
Natsuyo Yamamoto ◽  
Yousuke Nakai ◽  
Tomotaka Saito ◽  
Kei Saito ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastrointestinal Tract ◽  
Fluid Collection ◽  
Adverse Event Rate ◽  
Plastic Stents ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Covered Metallic Stent

Abstract Background and study aims While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied. Contraindications for EUS-PCD are lack of encapsulation or adhesion to the gastrointestinal tract. Safety and effectiveness of early vs delayed (≥ 4 weeks) EUS-PCD were compared. Results A total of 35 patients underwent EUS-PCD (12 early and 23 delayed) using 19 large-bore fully-covered metallic stent and 16 plastic stents. The median diameter of PFC was 110 mm (40 – 180) and 122 mm (17 – 250) in the early and delayed drainage groups, respectively. Median time from onset of AP to drainage was 23 and 85 days for early and delayed drainage, respectively. The technical success rate of EUS-guided drainage was 100 %. Endoscopic necrosectomy was performed in six early and 16 cases of delayed drainage. The adverse event rate was 25 % (3 bleeding) and 13 % (2 perforations and 1 CO2 retention) in the early and delayed drainage groups, respectively. Two patients died (1 early and 1 delayed) due to multiorgan failure. Conclusion Endoscopic drainage and subsequent necrosectomy of symptomatic PFC within 4 weeks after onset of acute pancreatitis was feasible, given that the collection was encapsulated and attached to the gastrointestinal tract.

scholarly journals Analysis of Factors Associated with the Severity of Acute Pancreatitis according to Etiology

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Dae Bum Kim ◽  
Woo Chul Chung ◽  
Ji Min Lee ◽  
Kang-Moon Lee ◽  
Jung Hwan Oh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Pancreatic Necrosis ◽  
Fluid Collection ◽  
Contributing Factors ◽  
Pancreatic Fluid Collection ◽  
Current Smoking ◽  
Factors Associated ◽  
Pancreatic Fluid ◽  
Index Of Severity

Background. The objective of this study was to determine the factors associated with severity of acute pancreatitis (AP) according to two major etiologies: alcohol and gallstones. Methods. We reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. A total of 905 patients with AP (660 alcohol-induced, 245 gallstone-induced) were enrolled. Among them, severe AP (SAP) occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Contributing factors between patients with and without SAP were analyzed according to the etiology. Results. Multivariate analysis demonstrated that current smoking, pancreatic necrosis, and bacteremia were associated with AP severity in both alcohol- and gallstone-induced AP. Pancreatic fluid collection was significantly associated with alcohol-induced SAP (p=0.04), whereas dyslipidemia was significantly associated with gallstone-induced SAP (p=0.01). Body mass index was significantly correlated with the Bedside Index of Severity in Acute Pancreatitis score in both alcohol- and gallstone-induced AP (p=0.03 and 0.01, resp.). Conclusions. Current smoking, pancreatic necrosis, and bacteremia can aggravate the clinical course of AP. Pancreatic fluid collection and dyslipidemia were associated with AP severity according to the different etiologies. Obesity may also be associated with AP severity in both etiologies.

scholarly journals Comparative Randomized Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In The Endoscopic Ultrasound-guided Drainage Of Walled-off Pancreatic Necrosis

2019 ◽  
Author(s):  
joan b gornals ◽  
Manuel Perez-Miranda ◽  
Enrique Vazquez-Sequeiros ◽  
Juan Vila ◽  
Jose M Esteban ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Plastic Stents ◽  
Metal Stents ◽  
Controlled Clinical Trial ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Tertiary Hospitals ◽  
Walled Off Necrosis

Abstract Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved.Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to <50% or < 5cm in size), along with clinical improvement. Secondary endpoints: the long-term (4 months) clinical success (total resolution or 5cm); the procedure’s duration, the level of difficulty, safety and recurrences.Discussion: The PROMETHEUS trial has been designed to response if LAMS are superior over PLASTIC stents in the EUS-guided transmural drainage of WON. Trial registration: ClinicalTrials.gov, NCT03100578. Registered on April 4, 2017. https://clinicaltrials.gov/ct2/home

Metal Versus Plastic Stents for Pancreatic Fluid Collection Drainage

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Xianzhu Zhou ◽  
Han Lin ◽  
Xiaoju Su ◽  
Pingping Zhang ◽  
Chunting Fu ◽  
...  
Keyword(s):  
Fluid Collection ◽  
Plastic Stents ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid

scholarly journals Unusual presentation of acute pancreatitis mimicking strangulated inguinal hernia in a patient with bladder exstrophy: a rare case report

2017 ◽  
Vol 4 (8) ◽  
pp. 2871
Author(s):  
Vijayakumar C. ◽  
Reddy VJ ◽  
Elamurugan T. P. ◽  
Jagdish S.
Keyword(s):  
Acute Pancreatitis ◽  
Inguinal Hernia ◽  
Clinical Presentation ◽  
Fluid Collection ◽  
Bladder Exstrophy ◽  
Unusual Presentation ◽  
Pancreatic Fluid Collection ◽  
Abdominal Symptoms ◽  
Pancreatic Fluid ◽  
Rare Case Report

Acute pancreatitis (AP) is a common surgical emergency. Apart from the typical clinical presentation, unusual presentations are also reported in literature. Here we present a case of acute pancreatitis presenting as a strangulated inguinal hernia. A 45-year-old male with a neglected bladder exstrophy and reducible left inguinal hernia since childhood presented with pain over the left inguinal swelling for three days duration. Patient was initially managed conservatively since there were no signs of complication. After initial conservative management, the patient developed features of strangulation and was taken up for inguinoscrotal exploration. Intra-operatively, direct inguinal hernial sac was identified without any bowel obstruction. Further explorative laparotomy revealed an inflamed, bulky pancreas. The peri-pancreatic fluid aspirated intra-operatively had an amylase value of >4000 IU. Postoperative period was uneventful and patient was discharged after 8 days. In this case an already reducible hernia became irreducible due to pancreatic fluid collection and inflammation of contents. Lack of abdominal symptoms or signs can lead to misdiagnosis and unnecessary surgery. We report an unusual presentation of acute pancreatitis mimicking a strangulated inguinal hernia in a patient with bladder exstrophy.

scholarly journals Perivesicular Abscess Drainage with Lumen-Apposing SelfExpanding Metal Stents

2020 ◽  
Vol 12 (3) ◽  
pp. 206-210
Author(s):  
Gabriel Melki ◽  
Abdalla Mohamed ◽  
Yana Cavanagh ◽  
Walid Baddoura ◽  
Matthew Grossman
Keyword(s):  
Large Diameter ◽  
Fluid Collection ◽  
Plastic Stents ◽  
Metal Stents ◽  
Abscess Drainage ◽  
Pancreatic Fluid Collection ◽  
Therapeutic Modalities ◽  
Abdominal Abscesses ◽  
Pancreatic Fluid ◽  
Self Expanding Metal Stents

Abdominal and pelvic abscesses can occur due to a number of reasons, the most common being surgery. They are associated with significant morbidity and mortality. The treatment approach for these types of collections is often the initiation of broad-spectrum antibiotics, accompanied by drainage. Multiple diagnostic and therapeutic modalities have been described, including; percutaneous, transvaginal, endoscopic, and surgicaldrainage. Due to the complexity of pelvic anatomy, minimally invasive approaches such as percutaneous drainage are usually difficult. Pelvic abscesses have been historically drained through surgery. Endoscopic ultrasound (EUS)-guided interventions have emerged as an alternative for the management of difficult abdominal and pelvic abscesses. Endoscopic interventions have classically included diagnostic and therapeutic aspiration, utilizing drainage catheters with or without placement of plastic stents. More recently, the use of lumen apposing self-expanding metal stents has become a treatment option for deep pelvic abscesses. Lumen opposing metal stents (LAMS) have a saddle-shaped design with two large-diameter flanges on both ends of the stent to anchor the stent edges within the respective lumens as well asa central waist that allows for communication between the two lumens. LAMS were originally designed for transmural pancreatic fluid collection drainage; however,they have been successfully implemented for numerous other off-label uses, including the drainage of pelvic and abdominal abscesses. We present the case of a 34-year-old womanwho presented with a septated abscess located between the urinary bladder and the rectum, which was successfully and definitively drained with LAMS.

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