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Novel and supplementary management of pancreatic fluid collections:Endoscopic ultrasound-guided drainage

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World Journal of Gastrointestinal Endoscopy 2017年第9期9卷 486-493页

作者： Si-Jie Hao Wei-Jia Xu Yang Di Lie Yao Hang He Feng Yang Chen Jin Liang Zhong De-Liang Fu Department of pancreatic surgery Huashan HospitalFudan University Department of Gastroenterology and Digestive Endoscopy Huashan HospitalFudan University

AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection *** Data were obtained retrospectively from January 2012 to December *** with pancreatic fluid collection were performed EUS-guided or surgical *** outcome measures including clinical efficiency,complication,duration of procedures,hospital stay and cost were *** Thirty-six patients were enrolled into the study,including 14 in endoscopic group while 22 in the surgical *** (86%) patients were treated successfully by endoscopic approach while 21 (95%) patients benefited through surgical *** treatment had higher recurrence and complication rates than surgery,resulting in more ***,duration of procedure,hospital stay and cost were significantly lower in endoscopic *** Both approaches were effective and ***-guided approach should be the first-line treatment in mild and simple cases,while surgical approach should be considered as priority in severe and complex cases.

关键词： Endoscopic ultrasound-guided drainage pancreatic fluid collection Post-operative pancreatic leakage Cyst-gastrostomy

Lumen apposing metal stents for pancreatic fluid collections:Recognition and management of complications

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World Journal of Gastrointestinal Endoscopy 2017年第9期9卷 456-463页

作者： Michael L DeSimone Akwi W Asombang Tyler M Berzin Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical Schoo Center for Advanced Endoscopy Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical School

For patients recovering from acute pancreatitis,the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery,and introduces difficult management decisions with regard to when,whether,and how the collection should be *** PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary *** approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement),and the placement of percutaneous *** drainage techniques have emerged in the last several years as the preferred approach for most patients,when local expertise is ***-apposing metal stents(LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections,and less commonly,for other indications,such as gallbladder *** considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding,migration,buried stent,stent occlusion,and *** of the patient complexity associated with severe pancreatitis,management of pancreatic fluid collections can be a complex and multidisciplinary *** and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques,including how to recognize and manage expected complications.

关键词： pancreatic fluid collection Lumen apposing metal stent Endoscopic necrosectomy Cystgastrostomy

Short-and long-term results of endoscopic ultrasoundguided transmural drainage for pancreatic pseudocysts and walled-off necrosis

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World Journal of Gastroenterology 2017年第39期23卷 7110-7118页

作者： Yuto Watanabe Rintaro Mikata Shin Yasui Hiroshi Ohyama Harutoshi Sugiyama Yuji Sakai Toshio Tsuyuguchi Naoya Kato Department of Gastroenterology Graduate School of Medicine Chiba University

AIM To evaluate the short-and long-term results of endoscopic ultrasound-guided transmural drainage(EUS-GTD) for pancreatic fluid collection(PFC) and identify the predictive factors of treatment outcome for walled-off necrosis(WON) managed by EUS-GTD *** We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON(n = 40), pancreatic pseudocyst(PPC; n = 11), chronic pseudocyst(n = 33), and others(n = 19). We evaluated the short-and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was *** In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis(OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC(OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3%(median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group(P = 0.02).CONCLUSION The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.

关键词： Endoscopic ultrasound-guided transmural drainage pancreatic fluid collection Revised Atlanta Classification Walled-off necrosis

Therapeutic interventional endoscopic ultrasound in pancreatobiliary disorders:Does it really replace the surgical/percutaneous approach?

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 537-547页

作者： Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha Rino Alvani Gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalMedical Faculty Universitas IndonesiaJakarta 10430Indonesia Digestive Disease and GI Oncology Center Medistra HospitalJakarta 12950Indonesia

Pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology,as they would sometimes require multi-approach interventional ***,therapeutic interventional endoscopic ultrasound(EUS)has emerged as a potential alternative to surgical or percutaneous ***,considering the high cost of EUS,lack of facility and expertise,most gastroenterologists still often refer cases to undergo surgical interventions without contemplating the possibility of utilizing EUS ***-guided biliary drainage has become one of the best choices for establishing access to biliary system,given the clear visualization of pancreas,gallbladder,and common bile *** there are still only a few studies which directly compare EUSguided and surgical approaches for biliary drainage,current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and reintervention rates,with similarly high technical and clinical success rates compared to percutaneous and surgical approaches,especially in patients with history of failed endoscopic retrograde cholangiopancreatography *** success rates with shorter length of hospital stay between endoscopic and surgical approaches have also been exhibited for pancreatic pseudocysts and walled-off *** findings about the progress of EUS approach in gastroenterostomy/jejunostomy also indicated a promising potential of EUS,as a less invasive approach,for managing gastric outlet obstruction.

关键词： Pancreato-biliary Endoscopic ultrasound Percutaneous approach Surgical approach Biliary drainage pancreatic fluid collection