What is the pancreatic duct size limit for a safe duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy? A retrospective study

Background. There were scarce trials concerning the treatments and outcomes of proximal pancreatic stent migration. Herein, we did a retrospective study to discuss this problem from an endoscopist’s point of view.Patients and Methods. From January 2009 to June 2014, patients with proximally migrated pancreatic duct stents were identified. Their clinical information was viewed. Retrieval techniques, success rates, and adverse events were analyzed.Results. A total of 36 procedures were performed in 34 patients; the median age of the patients was 53 years, with 17 males and 17 females. Eight patients’ pancreatic duct stents could still be seen in the major or minor papilla and were pulled out with a snare forceps or a grasping forceps; in the remaining 28 procedures, the management was somewhat thorny; the retrieval called for several devices. Final success was achieved in 31 patients. No adverse event was observed in the process of ERCP procedures, 5 patients developed post-ERCP pancreatitis (PEP), 1 patient got infection, and 1 patient had haemorrhage.Conclusions. Endoscopic retrieval of migrated pancreatic stent is safe and less invasive; nonetheless, attention should be paid so as to reduce the incidence and degree of related adverse events, especially PEP.

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Risk Factors for Post-ERCP Pancreatitis in High Risk Patients Who Have Undergone Prophylactic Pancreatic Duct Stenting: A Multicenter Retrospective Study

Internal Medicine ◽

10.2169/internalmedicine.50.6235 ◽

2011 ◽

Vol 50 (24) ◽

pp. 2927-2932 ◽

Cited By ~ 28

Author(s):

Kei Ito ◽

Naotaka Fujita ◽

Atsushi Kanno ◽

Hiroyuki Matsubayashi ◽

Shinji Okaniwa ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

High Risk ◽

Pancreatic Duct ◽

High Risk Patients ◽

Pancreatic Duct Stenting ◽

Risk Patients

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Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

10.21203/rs.2.15791/v3 ◽

2020 ◽

Author(s):

Kai-Shun Liang ◽

Chieh-Chang Chen ◽

Wei-Chih Liao ◽

Yu-ting Kuo ◽

Liang-Wei Tseng ◽

...

Keyword(s):

Retrospective Study ◽

Bile Duct ◽

Adverse Events ◽

Pancreatic Duct ◽

Complication Rate ◽

University Hospital ◽

Biliary Cannulation ◽

Access Rate ◽

Needle Knife ◽

Transpancreatic Sphincterotomy

Abstract Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF.Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed.Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred.Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.

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Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Retrospective Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8874504 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Gao Qing Wang ◽

Dipesh Kumar Yadav ◽

Wei Jiang ◽

Yong Fei Hua ◽

Cai De Lu

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Main Pancreatic Duct ◽

Surgical Complication ◽

Univariate Analysis ◽

Postoperative Pancreatic Fistula ◽

Soft Pancreas

Objectives. Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discuss the risk factors of pancreatic fistula in order to interpret the clinical importance. Methods. In this retrospective study, 263 patients who underwent DP at Ningbo Medical Center Li Huili Hospital between January 2011 and January 2020 were reviewed in accordance with relevant guidelines and regulations. Patients’ demographics and clinical parameters were evaluated using univariate and multivariate analyses to identify the risk factors contributing to CR-POPF. P < 0.05 was considered statistically significant. Results. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication (19.0%). The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct were more likely to develop pancreatic fistula. However, on multivariate analysis, the soft texture of the pancreas (OR = 2.381, 95% CI = 1.271–4.460, P = 0.001 ) and the ligation of the main pancreatic duct (OR = 0.388, 95% CI = 0.207–0.726, P = 0.002 ) were only an independent influencing factor for CR-POPF. Conclusions. As a conclusion, pancreatic fistula was the most common surgical complication after DP. The soft texture of the pancreas and the absence of ligation of the main pancreatic duct can increase the risk of CR-POPF.

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