S2345 Endoscopic Drainage of a Pancreatic Epithelial Cyst

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

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Changes in Cellular Regulatory Factors before and after Decompression of Odontogenic Keratocysts

Journal of Clinical Medicine ◽

10.3390/jcm10010030 ◽

2020 ◽

Vol 10 (1) ◽

pp. 30

Author(s):

Slmaro Park ◽

Han-Sung Jung ◽

Young-Soo Jung ◽

Woong Nam ◽

Jung Yul Cha ◽

...

Keyword(s):

Recurrence Rate ◽

Biological Behavior ◽

Nuclear Antigen ◽

Epithelial Cyst ◽

Ki 67 ◽

Proliferation Markers ◽

Odontogenic Keratocysts ◽

Wide Range ◽

Before And After ◽

Cyst Lining

Decompression followed by enucleation, which is one of the treatments used for odontogenic keratocysts (OKCs), is frequently used in OKC lesions of large sizes. This method offers the advantage of minimizing the possibility of sensory impairment without creating a wide-range bone defect; moreover, the recurrence rate can be significantly lower than following simple enucleation. This study aimed to assess the changes in histology and expression of proliferation markers in OKCs before and after decompression treatment. A total of 38 OKC tissue samples from 19 patients who had undergone decompression therapy were examined morphologically and immunohistochemically to observe changes in proliferative activity before and after decompression. The markers used for immunohistochemistry (IHC) staining were Bcl-2, epidermal growth factor receptor (EGFR), Ki-67, P53, PCNA, and SMO. The immunohistochemistry positivity of the 6 markers was scored by using software ImageJ, version 1.49, by quantifying the intensity and internal density of IHC-stained epithelium. The values of Bcl-2, Ki-67, P53, proliferating cell nuclear antigen (PCNA), and SMO in OKCs before and after decompression showed no significant change. No correlation between clinical shrinkage and morphologic changes or expression of proliferation and growth markers could be found. There was no statistical evidence that decompression treatment reduces potentially aggressive behavior of OKC within the epithelial cyst lining itself. This might indicate that decompression does not change the biological behavior of the epithelial cyst lining or the recurrence rate.

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Primary Conjunctival Epithelial Cyst in the Orbit

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2010.51.6.885 ◽

2010 ◽

Vol 51 (6) ◽

pp. 885

Author(s):

Chan-Hui Yi ◽

Mi Sun Sung ◽

Hyoung-Gyun Kim ◽

Kyung-In Woo ◽

Yoon-Duck Kim

Keyword(s):

Epithelial Cyst

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Endoscopic drainage of pancreatic pseudocysts

Practical Pediatric Gastrointestinal Endoscopy ◽

10.1002/9781119423492.ch38 ◽

2021 ◽

pp. 343-346

Author(s):

Mike Thomson

Keyword(s):

Pancreatic Pseudocysts ◽

Endoscopic Drainage

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Utility of endoscopic transpapillary pancreatic cyst drainage for intraductal papillary mucinous neoplasm infection

BMJ Case Reports ◽

10.1136/bcr-2021-242583 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242583

Author(s):

Shunsuke Watanabe ◽

Masao Toki ◽

Junji Shibahara ◽

Tadakazu Hisamatsu

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Cyst Wall ◽

Pancreatic Cyst ◽

Epigastric Pain ◽

Drainage Tube ◽

Endoscopic Drainage ◽

Endoscopic Retrograde Pancreatography ◽

Endoscopic Retrograde ◽

Mucinous Neoplasm ◽

Route Of Infection

A 61-year-old woman with intraductal papillary mucinous neoplasm (IPMN) infection, who was treated with antibiotics, developed IPMN reinfection with febrile epigastric pain and was febrile. CT showed that the diameter of the IPMN had grown and hardened, with thickening of the cyst wall. Endoscopic retrograde pancreatography was then performed and a nasopancreatic cyst drainage tube was placed into the cyst. Symptoms and inflammatory findings improved considerably 17 days after endoscopic drainage. Few reports and evidence have been found regarding IPMN infections, and the frequency of onset, route of infection and optimal drainage method remain unknown. This study indicated that endoscopic transpapillary pancreatic cyst drainage was effective and is highly recommended for IPMN infection.

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