Feasibility of a complete pancreatobiliary linear endoscopic ultrasound examination from the stomach

Abstract Background and study aims Linear endoscopic ultrasound (EUS) evaluation of the pancreaticobiliary system usually requires scanning from both the stomach and the duodenum. The feasibility of assessing the complete pancreaticobiliary system from the stomach alone has not been studied. We aimed to conceptualize a system-based approach (the railroad approach) for linear pancreaticobiliary EUS (PB-EUS) and evaluate whether the pancreaticobiliary anatomy could be assessed from the stomach alone. Patients and methods Three maneuvers were conceptualized and evaluated (the alpha maneuver in the stomach, and sigma and xi maneuvers in the duodenum). The maneuvers were prospectively evaluated in 100 consecutive patients requiring PB-EUS. Results The median procedure time for the three maneuvers was significantly higher than that for the alpha maneuver alone (12 vs. 6 minutes; P ≤ 0.001). The visualization rate of the hilum and common hepatic duct was significantly higher from the stomach than from the duodenum (100 % vs. 83.5 %; P ≤ 0.001), while rates for the head of the pancreas (100 % vs 100 %) and uncinate process (100 % vs 100 %) did not differ. The suprapancreatic common bile duct (CBD; 92 % vs 100 %; P = 0.006), retropancreatic CBD (95 % vs 100 %; P = 0.06), and pancreatic duct in the head (94 % vs 100 %; P = 0.03) were not completely visualized from the stomach, because of pancreatic calcification or shadow from the ligaments. The EUS diagnosis made from the stomach and duodenum did not differ after excluding body and tail lesions (pancreatic head neoplasms, 100 % vs 100 %; CBD stone, 100 % vs 84.6 %; pancreatic cysts in the head, 83.3 % vs 83.3 %, respectively). Conclusions Adequate anatomical and diagnostic information on the pancreaticobiliary system may be acquired by EUS scanning from the stomach alone and with a shorter procedure time.

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Non-functioning neuroendocrine tumors of the common hepatic duct: a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20170869 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1101

Author(s):

Maroun Abou-Jaoude ◽

Haydar A. Nasser

Keyword(s):

Neuroendocrine Tumors ◽

Epigastric Pain ◽

Hepatic Duct ◽

Young Patients ◽

Pancreatic Head ◽

Long Term Results ◽

Common Hepatic Duct ◽

The Common ◽

Well Differentiated

Extra-hepatic biliary tree neuroendocrine tumors are not common, accounting for about 0.1 % of all carcinoid tumors. Those affecting the common hepatic duct are very rare and their diagnosis is usually made post-operatively. Poorly differentiated tumors or neuroendocrine carcinomas are commonly seen in elderly, whereas well differentiated tumors, tend to occur in young patients, for whom surgery will lead to good long term results. About 100 cases have been reported in the English medical literature, showing good long term results after surgery for well differentiated (Grades 1 and 2) tumors. Herein, we report a case of an 18-year-old female, complaining from a dull epigastric pain related to a nodule compressing the common hepatic duct. After complete investigation, a laparotomy has been performed and showed a nodular tumor located in the common hepatic duct just above the insertion of the cystic duct with close contact with the pancreatic head distally. En bloc cholecystectomy with bile duct resection was performed and followed by a Roux-en-Y hepatico-jejunostomy. The pathology of the nodule came back to be a neuroendocrine tumor grade 2.

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Performance of endoscopic ultrasound for diagnosis of agenesis of the dorsal pancreas: a case report

Journal of International Medical Research ◽

10.1177/0300060519884148 ◽

2019 ◽

Vol 48 (5) ◽

pp. 030006051988414

Author(s):

Jin Wei Zhong ◽

Ling Min Yu ◽

Qing Ji Ying ◽

Wen Wen Peng ◽

Chang Zhao Xu ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Pancreatic Head ◽

Magnetic Resonance Cholangiopancreatography ◽

Final Diagnosis ◽

Dorsal Pancreas ◽

Pancreatic Body ◽

Head Of The Pancreas

Agenesis of the dorsal pancreas is a rare congenital pancreatic malformation. We herein describe a 67-year-old woman with a 5-day history of lower back pain who was eventually diagnosed with agenesis of the dorsal pancreas. Abdominal computed tomography showed an enlarged pancreatic head, but the pancreatic body and tail were invisible. The magnetic resonance imaging findings were similar to the computed tomography findings. Magnetic resonance cholangiopancreatography showed that the major pancreatic duct was mildly dilated but otherwise normal. Endoscopic ultrasound revealed absence of the pancreatic body and tail, an enlarged head of the pancreas, and mild pancreatic duct dilation. The final diagnosis was dorsal pancreatic agenesis.

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Definition of Pancreatic Cysts within Pancreatic Calcification: Report of Two Cases

Gastroenterology ◽

10.1016/s0016-5085(52)80045-9 ◽

1952 ◽

Vol 21 (3) ◽

pp. 439-443 ◽

Cited By ~ 6

Author(s):

Gilbert H. Alexander ◽

Ralph J. Lowder

Keyword(s):

Pancreatic Cysts ◽

Pancreatic Calcification ◽

Definition Of

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Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

International Journal of Development Research ◽

10.37118/ijdr.18563.05.2020 ◽

2020 ◽

pp. 35871-35873

Keyword(s):

Surgical Technique ◽

Cystic Duct ◽

Hepatic Duct ◽

Signs And Symptoms ◽

Mirizzi Syndrome ◽

Common Hepatic Duct ◽

Clinical Aspects ◽

Main Diagnosis ◽

Biliary Surgery ◽

Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

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Clinical impact of endoscopic ultrasound-guided through-the-needle microbiopsy in patients with pancreatic cysts

Endoscopy ◽

10.1055/a-1259-1409 ◽

2020 ◽

Vol 53 (01) ◽

pp. 103-103

Author(s):

Stephen A. Firkins ◽

Somashekar G. Krishna

Keyword(s):

Endoscopic Ultrasound ◽

Clinical Impact ◽

Pancreatic Cysts ◽

Ultrasound Guided

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What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term “P–A ligament” based on anatomical findings

Anatomical Science International ◽

10.1007/s12565-020-00597-1 ◽

2021 ◽

Author(s):

Satoru Muro ◽

Wachirawit Sirirat ◽

Daisuke Ban ◽

Yuichi Nagakawa ◽

Keiichi Akita

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Pancreatic Head ◽

Celiac Trunk ◽

Dorsal Side ◽

Uncinate Process ◽

Anatomical Basis ◽

The Right ◽

Upper Abdomen ◽

Macroscopic Examination

AbstractA plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

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