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Pankaj N. Desai (Department of Endoscopy & Endosonography Surat Institute of Digestive Sciences (SIDS) Surat Ind) Chintan N. Patel (Department of Endoscopy & Endosonography Surat Institute of Digestive Sciences (SIDS) Surat Ind) Mayank V. Kabrawala (Department of Endoscopy & Endosonography Surat Institute of Digestive Sciences (SIDS) Surat Ind) Subhash K. Nandwani (Department of Gastroenterology Surat Institute of Digestive Sciences (SIDS) Surat India) Rajiv M. Mehta (Department of Gastroenterology Surat Institute of Digestive Sciences (SIDS) Surat India) Ritesh M. Prajapati (Department of Gastroenterology Surat Institute of Digestive Sciences (SIDS) Surat India) Nisharg B. Patel (Department of Gastroenterology Surat Institute of Digestive Sciences (SIDS) Surat India) Krishna K. Parekh (Department of Clinical Research Surat Institute of Digestive Sciences (SIDS) Surat India) Neha D. Sheth (Department of Clinical Research Surat Institute of Digestive Sciences (SIDS) Surat India)
저널정보
소화기인터벤션의학회 International Journal of Gastrointestinal Intervention International Journal of Gastrointestinal Intervention 제10권 제1호
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2021.1
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1 - 5 (5page)

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Background: To assess the usefulness of endoscopic pancreatography without contrast agents and efficacy of transpapillary intervention for pancreatic duct (PD) rupture in chronic pancreatitis. Methods: We retrospectively analyzed all cases of chronic pancreatitis with ductal rupture causing ascites, effusions and pseudocysts. We performed magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde pancreatography (ERP) without contrast. Results observed based on the possibility of wire crossing the leak or not and their resolutions were noted. Results: We performed ERP in 1,324 patients. Ductal disruptions in 321/1,324 (24.2%). We divided cases into two groups. Group 1 involves disruptions causing ascites in 60 cases (18.7%) and effusions in 34 cases (10.6%), and group 2 involves pseudocysts in 227 cases (70.7%). In group 1, 82 patients (87.2%) experienced successful cannulation of PD. Leak crossed in 70 (74.5%) with complete resolution in all. Leak did not cross in 12 cases of which 8 (8.5%) installed stents resolved while four (4.3%) did not resolve. In group 2, 219 (96.5%) PD cannulated. Leak did not cross but stents put in cyst (176, 77.5%). Complete resolution occurred without infection. Leaks were crossed in 43 (18.9%); complete resolution, 14 (32.6%). Complete regression was not achieved in 19 (8.3%). Eight cysts were not resolved (3.5%). Transmural drainage was done. Infection was noted in 2 cases (0.9%). Sites of leak in pseudocysts were jenu & body, 167 (73.6%); tail, 60 (26.4%). We recorded pancreas divisum in 24/321 (7.5%). ERP failed in 20 (6.2%). Three were managed medically (1.3%), 5 with distal pancreatectomy (2.2%), 4 with lateral pancreatico jejunostomy (1.8%), and 8 with transmural drainage (3.5%). Conclusion: PD rupture in chronic pancreatitis can be managed transpapillary, without any contrast during ERP. In majority, endosonography aspiration and transmural drainage are needed only when transpapillary fails. Leak from tail responded better than those from proximal duct with ERP.
#Chronic pancreatitis #Endoscopic retrograde cholangiopancreatography #Pancreatic ducts #Retrospective studies

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참고문헌 (8)

참고문헌 신청
Larsen M / 2014 / Management of pancreatic ductal leaks and fistulae / J Gastroenterol Hepatol 29:1360~1370 google schola Dominguez-Munoz JE / 2018 / Recommendations from the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis / Pancreatology 18:847~854 google schola Tanaka T / 2013 / Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system / Pancreatology 13:621~624 google schola Kozarek RA / 1991 / Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections / Gastroenterology 100:1362~1370 google schola Trevino JM / 2010 / Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections / J Gastroenterol Hepatol 25:526~531 google schola

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