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Role of pancreatography in the endoscopic management of encapsulated pancreatic collections-review and new proposed classification

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World Journal of Gastroenterology 2020年第45期26卷 7104-7117页

作者： Igor Mendonca Proença Marcos Eduardo Lera dos Santos Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Sergio Eiji Matuguma Spencer Cheng Thomas R McCarty epifanio silvino do monte junior Paulo Sakai Eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Department of GastroenterologyHospital das ClinicasUniversity of Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s Hospital-Harvard Medical SchoolBostonMA 02115United States

Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or *** the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous *** understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct ***,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic *** to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde *** the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the ***,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.

关键词： Endoscopic retrograde cholangiopancreatography Endoscopy Endoscopic ultrasound Pseudocyst Endosonography Pancreatic ducts

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Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review

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World Journal of Gastroenterology 2021年第20期27卷 2495-2506页

作者： Igor Braga Ribeiro epifanio silvino do monte junior Antonio Afonso Miranda Neto Igor Mendonça Proença Diogo Turiani Hourneaux de Moura Mauricio Kazuyoshi Minata Edson Ide Marcos Eduardo Lera dos Santos Gustavo de Oliveira Luz Sergio Eiji Matuguma Spencer Cheng Renato Baracat Eduardo Guimarães Hourneaux de Moura Department of Gastrointestinal Endoscopy Unit University of São Paulo School of MedicineSão Paulo 05403-010Brazil

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk ***-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse *** studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage *** review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

关键词： Endoscopic retrograde cholangiopancreatography Pan-creatitis Postendoscopic retrograde cholangiopancreatography pancreatitis Adverse events Pancreatitis Prevention

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Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography:A systematic review and meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 718-730页

作者： Maria Fernanda Shinin Merchan Diogo Turiani Hourneaux de Moura Guilherme Henrique Peixoto de Oliveira Igor Mendonça Proença epifanio silvino do monte junior Edson Ide Caroline Moll Sergio A Sánchez-Luna Wanderley Marques Bernardo Eduardo Guimarães Hourneaux de Moura Department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Department of Internal Medicine University of Alabama at Birmingham Heersink School of MedicineBirminghamAL 35233United States

BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still *** To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective *** This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.A comprehensive search of multiple electronic databases was *** randomized controlled trials were *** outcomes analyzed included bacteremia,cholangitis,sepsis,pancreatitis,and *** risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled *** quality of evidence was assessed by the Grading of Recommendation Assessment,Development,and ***-analysis was performed using the Review Manager 5.4 *** Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were *** was no significant difference between groups regarding incidence of cholangitis after ERCP[risk difference(RD)=-0.02,95%confidence interval(CI):-0.05,0.02,P=0.32,cholangitis in patients with suspected biliary obstruction(RD=0.02,95%CI:-0.08 to 0.13,P=0.66),cholangitis on intravenous antibiotic prophylaxis(RD=-0.02,95%CI:-0.05 to 0.01,P=0.25),septicemia(RD=-0.02,95%CI:-0.06 to 0.01,P=0.25),pancreatitis(RD=-0.02,95%CI:-0.06 to 0.01,P=0.19),and allcause mortality(RD=0.00,95%CI:-0.01 to 0.01,P=0.71).However,the antibiotic prophylaxis group presented a 7%risk reduction in the incidence of bacteremia(RD=-0.07,95%CI:-0.14 to-0.01,P=0.03).CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis,septicemia,pancreatitis,and mortality.

关键词： Endoscopy Antibiotics Endoscopic retrograde cholangiopancreatography Cholangitis Infection

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Preemptive endoluminal vacuum therapy after pancreaticoduodenectomy: A case report

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World Journal of Gastrointestinal Endoscopy 2020年第11期12卷 493-499页

作者： Flaubert Sena de Medeiros epifanio silvino do monte junior Romero de Lima França Heli Clóvis de Medeiros Neto Juliany Medeiros Santos Eligio Alves Almeida Júnior Samuel Oliveira da Silva Júnior Mario Herman Santos Moura Pedreira Tavares Eduardo Guimarães Hourneaux de Moura Department of Surgery Federal University of Rio Grande do NorteNatal 59012-300Rio Grande do NorteBrazil Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-000Brazil Department of Surgery Hospital do CoraçãoNatal 59075-050Rio Grande do NorteBrazil Gastrointestinal Endoscopy Unit Faculty of Medicine of ABCSão Paulo 09190-615Brazil Department of Surgery Instituto Juarez AlmeidaBacabal 65700-000MaranhãoBrazil Department of Surgery Hospital Naval Marcílio DiasRio de Janeiro 20725-090Rio de JaneiroBrazil

BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic *** a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic *** have been no previous reports on preemptive EVT after *** SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and *** examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile *** resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was *** system comprised a nasogastric tube,gauze,and an antimicrobial incise *** negative pressure was 125 mmHg,and no adverse events *** patient was discharged on postoperative day 5 without any *** Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.

关键词： Preemptive Endoluminal Vacuum Pancreaticoduodenectomy Case report

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