scholarly journals Pancreatic Stent Placement is Associated with Resolution of Refractory Grade C Pancreatic Fistula after Left-Sided Pancreatectomy

2009 ◽  
Vol 75 (8) ◽  
pp. 654-658 ◽  
Author(s):  
Stephen R. Grobmyer ◽  
Darrell L. Hunt ◽  
Christopher E. Forsmark ◽  
Peter V. Draganov ◽  
Kevin E. Behrns ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Median Time ◽  
Stent Placement ◽  
Morbidity And Mortality ◽  
Pancreatic Stent ◽  
Endoscopic Retrograde ◽  
Percutaneous Catheter ◽  
Pancreatic Fistulas ◽  
Fluid Collections ◽  
Operative Drainage

Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and resolve quickly with no intervention. Grade C pancreatic fistulas, which require percutaneous or operative drainage, are less common and may be associated with morbidity and mortality. We used postoperative endoscopic pancreatic stent placement as an adjunctive strategy in the management of refractory Grade C pancreatic fistulas. Patients undergoing endoscopic pancreatic stent placement for persistent, refractory peripancreatic fluid collections/pancreatic fistula after left-sided pancreatectomy were identified. Eight patients underwent endoscopic pancreatic stent placement for refractory Grade C pancreatic fistulas. Six patients had percutaneous catheter placement; two patients had trans-gastric drainage. Endoscopic retrograde cholangiopancreatography (ERCP) showed extravasation of contrast from the distal end of the pancreatic duct in seven patients. Pancreatic stents were placed in all patients at a median time of 48 days postoperation and left for a median of 47 days. Before stent removal, ERCP demonstrated pancreatic fistula closure. Median time to complete resolution of the fistula was 41 days after stent placement. Endoscopic pancreatic stents were associated with resolution of Grade C fistulas. After distal pancreatectomy, pancreatic stent placement should be considered in the postoperative period for refractory pancreatic fistulas.

scholarly journals Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

2015 ◽  
Vol 4 (2) ◽  
pp. 67-71
Author(s):  
Hossein Ajdarkosh ◽  
Gholamreza Hemasi ◽  
Farhad Zamani ◽  
Masoudreza Sohrabi ◽  
Mohammad Mahdi Zamani ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Stent Placement ◽  
Guide Wire ◽  
High Risk Population ◽  
Pancreatic Stent ◽  
Stent Group ◽  
Endoscopic Retrograde ◽  
Pancreatic Duct Stent

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]

scholarly journals Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259701
Author(s):  
Koki Maeda ◽  
Naohisa Kuriyama ◽  
Yuki Nakagawa ◽  
Takahiro Ito ◽  
Aoi Hayasaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
Intervention Group ◽  
Postoperative Pancreatic Fistula ◽  
Optimal Management ◽  
Duration Of Hospitalization ◽  
Pancreatic Fistulas ◽  
Fluid Collections

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

Calcific intra-pancreatic embedding of a pancreatic stent necessitating surgical removal—a danger of chronic endoscopic retrograde pancreatic stent placement

1999 ◽  
Vol 50 (6) ◽  
pp. 860-862 ◽  
Author(s):  
A.M.James Shapiro ◽  
Charles H. Scudamore ◽  
Laura V. July ◽  
Andrzej K. Buczkowski ◽  
Stephen W. Chung ◽  
...  
Keyword(s):  
Stent Placement ◽  
Surgical Removal ◽  
Pancreatic Stent ◽  
Endoscopic Retrograde

Endoscopic Management of Bowel Obstruction

2021 ◽  
Author(s):  
David E. Beck
Keyword(s):  
Bowel Obstruction ◽  
Systematic Reviews ◽  
Patient Selection ◽  
Stent Placement ◽  
Morbidity And Mortality ◽  
Endoscopic Management ◽  
Traditional Management ◽  
Patient Status

AbstractThe traditional morbidity and mortality associated with traditional management has stimulated exploration of endoscopic approaches. Success depends on patient selection, the location and etiology of obstruction, patient status, and the capability of the endoscopist. This article discusses techniques of intralumenal dilation and stent placement and results from systematic reviews.

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