Endoscopic treatment of pancreatic abscesses and pseudocysts: Endoscopic transpapillary drainage and endoscopic drainage guided by endosonography

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 Drainage of Pancreatic Pseudocysts: An Experience with 77 Patients

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_79_16 ◽

2017 ◽

Vol 08 (02) ◽

pp. 061-067

Author(s):

Hemanta K. Nayak ◽

Sandeep Kumar ◽

Uday C. Ghoshal ◽

Samir Mohindra ◽

Namita Mohindra ◽

...

Keyword(s):

Long Term Results ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Stent Occlusion ◽

Northern India ◽

Short And Long Term ◽

Transpapillary Drainage ◽

And Migration ◽

Lost To Follow Up

ABSTRACT Background: We evaluated short‑ and long‑term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy‑seven patients (56 males), median age 36 years (range, 15–73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8–68), large (volume 582 mL [range, 80–2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty‑nine patients were followed up (median 28 months, range 2–156; other eight lost to follow‑up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001–0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03–135.95). Conclusion: Endoscopic drainage is safe and effective for PPC.

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Endoscopic treatment of pancreatic pseudocysts cystoenterostomy and transpapillary drainage

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(96)80452-4 ◽

1996 ◽

Vol 43 (4) ◽

pp. 404

Author(s):

E Della ◽

Libera Jr ◽

ES Siqueira ◽

CO Brant ◽

M Morais ◽

...

Keyword(s):

Endoscopic Treatment ◽

Pancreatic Pseudocysts ◽

Transpapillary Drainage

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Early endoscopic treatment of symptomatic pancreatic necrotic collections

Scientific Reports ◽

10.1038/s41598-021-03924-2 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Mateusz Jagielski ◽

Jacek Piątkowski ◽

Marek Jackowski

Keyword(s):

Success Rate ◽

Endoscopic Treatment ◽

Clinical Success ◽

Late Phase ◽

Clinical Success Rate ◽

Endoscopic Drainage ◽

Endoscopic Intervention ◽

Average Total Number ◽

Group 2

AbstractEUS-guided transmural endoscopic drainage is commonly used in the treatment of WOPN in the late phase of ANP. The role of endoscopic intervention remains unclear in the early phase of ANP. This study aimed to prospectively evaluate early endoscopic treatment of ANCs compared with endoscopic drainage of WOPN. Overall, 71 patients with ANP who underwent transmural endoscopic drainage for necrotic collections were included. Endoscopic intervention was performed within the first four weeks of ANP in 25 (35.21%) patients with ANC (Group 1) and in 46 (64.79%) patients after four weeks since the onset of ANP with WOPN (Group 2). The overall mean age of patients was 49.9 (22–79) years and 59 of them were males. The mean time of active drainage and duration of total endoscopic treatment was 26.8 and 16.9 days (P = 0.0001) and 270.8 and 164.2 days (P = 0.0001) in Groups 1 and 2, respectively. The average total number of endoscopic interventions was 9.5 and 4.5 in Groups 1 and 2, respectively (P = 0.0001). The clinical success rate, frequency of complications of endoscopic interventions, long-term success rate, and recurrence rate were not significantly different between the groups (P > 0.05 for each). Transmural endoscopic drainage is effective method of treatment of early ANCs within the first four weeks of ANP. However, compared with endoscopic intervention in WOPN, more interventions and longer duration of drainage are required.

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Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

10.21203/rs.2.14201/v3 ◽

2020 ◽

Author(s):

Fadi Younis ◽

Mati Shnell ◽

Nathan Gluck ◽

Subhi Abu-Abeid ◽

Shai Eldar ◽

...

Keyword(s):

Gastric Bypass ◽

Endoscopic Treatment ◽

Staple Line ◽

One Anastomosis Gastric Bypass ◽

Metal Stents ◽

Pneumatic Dilation ◽

Endoscopic Drainage ◽

Oral Nutrition ◽

Anastomotic Strictures ◽

Staple Line Leaks

Abstract Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results : Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

10.21203/rs.2.14201/v2 ◽

2019 ◽

Author(s):

Fadi Younis ◽

Mati Shnell ◽

Nathan Gluck ◽

Subhi Abu-Abeid ◽

Shai Eldar ◽

...

Keyword(s):

Gastric Bypass ◽

Endoscopic Treatment ◽

Staple Line ◽

One Anastomosis Gastric Bypass ◽

Metal Stents ◽

Pneumatic Dilation ◽

Endoscopic Drainage ◽

Oral Nutrition ◽

Anastomotic Strictures ◽

Staple Line Leaks

Abstract Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results : Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilatation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection

Surgical Endoscopy ◽

10.1007/s00464-021-08359-4 ◽

2021 ◽

Author(s):

Mateusz Jagielski ◽

Jacek Piątkowski ◽

Grzegorz Jarczyk ◽

Marek Jackowski

Keyword(s):

Anastomotic Leakage ◽

Endoscopic Treatment ◽

Malignant Tumors ◽

Vacuum Therapy ◽

Endoscopic Drainage ◽

Anastomotic Leaks ◽

Rectal Tumors ◽

Invasive Treatment ◽

Protective Ileostomy ◽

The Mean

Abstract Background Surgery is the gold standard for the treatment of malignant tumors of the rectum. Intestinal anastomotic leakage remains a serious complication of colorectal surgery. The efficacy and safety of transrectal endoscopic drainage by vacuum therapy in patients with intestinal anastomotic leakage after surgical treatment of middle and distal rectal tumors were assessed. Methods Prospective analysis of treatment outcomes among patients undergoing surgery for middle and distal rectal tumors at the Department of General, Gastroenterological, and Oncological Surgery of the Ludwik Rydygier Collegium Medicum in Bydgoszcz and Nicolaus Copernicus University in Torun from 2016 to 2019 was conducted. Results Seventy-nine patients with middle and distal rectal tumors underwent laparoscopic resection. Intestinal anastomotic leak was identified in 18 (22.79%) patients [all men, mean age 61.39 (43–86) years] during the postoperative period. Primary protective ileostomy was performed in 8/18 (44.44%) patients. All 18 patients were treated with endoluminal vacuum therapy via transrectal endoscopic drainage. The mean time from surgery to the diagnosis of leakage and initiation of endoscopic treatment was 16 (3–728) days. The mean number of endoscopic procedures per patient was 6 (1–11). The mean duration of endoscopic treatment was 22 (4–43) days. Complications of endotherapy occurred in 2/18 (11.11%) patients treated endoscopically for bleeding from the abscess cavity. Success of endoluminal vacuum therapy was achieved in 17/18 (94.44%) patients. Moreover, 5/18 (27.78%) patients required ileostomy during the endoscopic treatment. The mean follow-up period was 368 (118–724) days. Long-term success of transrectal endoscopic drainage using vacuum-assisted therapy was achieved in 15/18 (83.33%) patients. Conclusions Endoscopic rectal drainage using vacuum-assisted therapy is an effective and safe minimally invasive treatment in patients with intestinal anastomotic leaks following resection procedures within the middle and distal rectum.

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Endoscopic treatment of leaks and strictures after laparoscopic one anastomosis gastric bypass

10.21203/rs.2.14201/v1 ◽

2019 ◽

Author(s):

Fadi Younis ◽

Mati Shnell ◽

Nathan Gluck ◽

Subhi Abu-Abeid ◽

Shai Eldar ◽

...

Keyword(s):

Gastric Bypass ◽

Endoscopic Treatment ◽

Staple Line ◽

One Anastomosis Gastric Bypass ◽

Metal Stents ◽

Pneumatic Dilation ◽

Endoscopic Drainage ◽

Oral Nutrition ◽

Anastomotic Strictures ◽

Staple Line Leaks

Abstract Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results: Nine patients presented with acute or early leaks: 5 (55.6%) had staple-line leaks, 3 (33.3%) had anastomotic leaks and 1 (11.1%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44.4%). Overall 5 patients (55.6%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22.2%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilatation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211032823 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110328

Author(s):

Rachel Hallit ◽

Mélanie Calmels ◽

Ulriikka Chaput ◽

Diane Lorenzo ◽

Aymeric Becq ◽

...

Keyword(s):

Anastomotic Leak ◽

Endoscopic Treatment ◽

Gastric Resection ◽

Endoscopic Management ◽

Endoscopic Drainage ◽

Anastomotic Leaks ◽

Internal Drainage ◽

Ivor Lewis ◽

Esophageal Stents ◽

Postoperative Leak

Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively ( p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage ( p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.

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