-
Abdominal Radiology (New York) Jan 2023Magnetic resonance cholangiopancreatography (MRCP) has become a widely accepted noninvasive diagnostic tool in the assessment of pancreatic and biliary disease. MRCP... (Review)
Review
Magnetic resonance cholangiopancreatography (MRCP) has become a widely accepted noninvasive diagnostic tool in the assessment of pancreatic and biliary disease. MRCP essentially exploits extended T2 relaxation times of slow-moving fluid and delineates the outline of biliary and pancreatic ducts on T2-weighted images. In order to maximize the clinical implication of MRCP, it is of utmost importance for radiologists to optimize the acquisition technique, be aware of patient-related factors and physiologic changes than can affect its performance and interpretation. It is critical to understand the most common artifacts and pitfalls encountered during acquisition and interpretation of MRCP. We provide a general overview of the different pitfalls encountered in MRCP and pearls on how to manage them in real-world practice.
Topics: Humans; Cholangiopancreatography, Magnetic Resonance; Pancreatic Diseases; Biliary Tract Diseases; Pancreatic Ducts; Bile Duct Diseases; Magnetic Resonance Imaging
PubMed: 34709455
DOI: 10.1007/s00261-021-03323-1 -
Current Gastroenterology Reports Jun 2020The purpose of this review is to discuss the role of endoscopic ultrasound (EUS) in the diagnosis and treatment of chronic pancreatitis (CP). (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to discuss the role of endoscopic ultrasound (EUS) in the diagnosis and treatment of chronic pancreatitis (CP).
RECENT FINDINGS
EUS has evolved and become invaluable in diagnosing early CP with the use of elastography and contrast enhancement. Lumen-apposing metal stents have allowed for easier transmural drainage and necrosectomy for pancreatic pseudocyst and walled of necrosis. EUS-guided pancreatic duct drainage is being utilized for pancreatic duct complications including stenosis, stones, and duct disruptions that are not amendable to endoscopic retrograde cholangiopancreatography. EUS is an effective tool that assists with the diagnosis and treatment of CP. The technology continues to evolve allowing for diagnosis of CP in earlier stages, which enables more effective therapy. The development of new EUS-guided tools and techniques has improved the treatment of complications from CP.
Topics: Abdominal Pain; Contrast Media; Debridement; Drainage; Elasticity Imaging Techniques; Endosonography; Humans; Nerve Block; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis, Chronic; Stents; Ultrasonography, Interventional
PubMed: 32500234
DOI: 10.1007/s11894-020-00772-4 -
Gastrointestinal Endoscopy Clinics of... Jul 2024Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is a method of decompressing the pancreatic duct (PD) if unable to access the papilla or surgical... (Review)
Review
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is a method of decompressing the pancreatic duct (PD) if unable to access the papilla or surgical anastomosis, particularly in nonsurgical candidates. The 2 types of EUS-PDD are EUS-assisted pancreatic rendezvous (EUS-PRV) and EUS-guided pancreaticogastrostomy (EUS-PG). EUS-PRV should be considered in patients with accessible papilla or anastomosis, while EUS-PG is a comparable alternative in surgically altered foregut anatomy. While technical and clinical successes range from 79% to 100%, adverse events occur in approximately 20%. A multidisciplinary approach that considers the patient's anatomy, clinical indication, and long-term goals should be discussed with surgical and interventional radiology colleagues.
Topics: Humans; Drainage; Pancreatic Ducts; Endosonography; Ultrasonography, Interventional; Stents
PubMed: 38796295
DOI: 10.1016/j.giec.2024.02.002 -
Gastrointestinal Endoscopy Clinics of... Jul 2024Per-oral pancreatoscopy (POP) is a pancreas-preserving modality that allows for targeted pancreatic duct interventions, particularly in cases where standard techniques... (Review)
Review
Per-oral pancreatoscopy (POP) is a pancreas-preserving modality that allows for targeted pancreatic duct interventions, particularly in cases where standard techniques fail. POP specifically has an emerging role in the diagnosis, risk stratification, and disease extent determination of main duct intraductal papillary mucinous neoplasms (IPMNs). It has also been successfully used for laser ablation of IPMNs in poor surgical candidates, lithotripsy for complex stone disease, and laser stricturoplasty. As experience with POP increases beyond select referral center practices, further studies validating POP efficacy with long-term follow-up will help clarify when POP-guided intervention is most beneficial in relation to surgical intervention.
Topics: Humans; Pancreatic Diseases; Endoscopy, Digestive System; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatic Intraductal Neoplasms
PubMed: 38796290
DOI: 10.1016/j.giec.2024.02.007 -
Digestive Endoscopy : Official Journal... May 2017Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed... (Review)
Review
Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumen-apposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. Success rate appears to be low for pancreatic duct drainage because of a variety of reasons. Outcomes of EUS-guided biliary drainage appear equivalent to percutaneous drainage and ERCP. EUS-guided gallbladder drainage appears promising for patients requiring gallbladder drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures.
Topics: Cholestasis; Drainage; Endosonography; Humans; Pancreatic Ducts; Patient Selection; Stents; Ultrasonography, Interventional
PubMed: 28118509
DOI: 10.1111/den.12818 -
Gastrointestinal Endoscopy Clinics of... Oct 2023Chronic pancreatitis (CP) is an ongoing inflammatory disease with most patients developing pancreatic calculi during their course of disease. Extracorporeal shock wave... (Review)
Review
Chronic pancreatitis (CP) is an ongoing inflammatory disease with most patients developing pancreatic calculi during their course of disease. Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment option in patients with large lumen obstructing pancreatic duct (PD) stones. In patients with CP and PD dilatation, digital single-operator pancreatoscopy (DSOP)-guided lithotripsy seems to be an appealing option to ESWL and surgery. DSOP-guided lithotripsy for the treatment of large symptomatic PD-stones has been demonstrated to be safe, technically, and clinically effective, and should be regarded as an alternative endoscopic treatment of certain patients.
Topics: Humans; Pancreatic Diseases; Pancreatitis, Chronic; Lithotripsy; Endoscopes, Gastrointestinal; Pancreatic Ducts
PubMed: 37709413
DOI: 10.1016/j.giec.2023.04.001 -
Journal of Hepato-biliary-pancreatic... Jan 2015Endoscopic ultrasound (EUS) has evolved from a purely diagnostic procedure to one with therapeutic capabilities. One of the most challenging therapeutic intervention for... (Review)
Review
Endoscopic ultrasound (EUS) has evolved from a purely diagnostic procedure to one with therapeutic capabilities. One of the most challenging therapeutic intervention for endosonographers is EUS-guided pancreatic drainage. The development of this technique has allowed access and drainage of the main pancreatic duct after failed endoscopic retrograde pancreatography and can avoid invasive procedures such as surgical and percutaneous interventions. This review discusses the indications, technique, challenges, and an algorithmic approach to EUS-guided pancreatic drainage.
Topics: Drainage; Endosonography; Humans; Pancreatic Diseases; Pancreatic Ducts; Surgery, Computer-Assisted
PubMed: 25385528
DOI: 10.1002/jhbp.187 -
Gut Sep 2022
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatic Ducts; Pancreatic Neoplasms
PubMed: 33963040
DOI: 10.1136/gutjnl-2021-324335 -
Current Opinion in Gastroenterology Sep 2019To review the current management of walled-off pancreatic necrosis (WOPN). (Review)
Review
PURPOSE OF REVIEW
To review the current management of walled-off pancreatic necrosis (WOPN).
RECENT FINDINGS
The management of WOPN has evolved. Many collections do not require intervention and may resolve over time. Nutritional support and treatment of infection are two critical components of medical management. For collections requiring drainage, minimally invasive endoscopic therapies now play a primary role. Endoscopic transmural puncture with stent placement may provide access for drainage and decompression. More complex collections may require transluminal instrumentation with lavage, debridement, and necrosectomy. Concurrent pancreatic duct injuries including strictures, leaks, and disconnections are very common. Addressing the pancreatic ductal injury is a key component in the long-term success of management strategies. Providing high-level care for patients requires a multidisciplinary approach with providers specialized in the management of severe acute pancreatitis and associated complications.
SUMMARY
Minimally invasive management strategies improve the outcomes for patients with WOPN. Close follow-up, medical therapy, and nutritional support are required for most patients. Endoscopic transmural drainage and necrosectomy are the primary approaches for collections requiring intervention. Protocols for endoscopic drainage are being refined to reduce side effects and decrease the number of interventions required for resolution.
Topics: Combined Modality Therapy; Debridement; Drainage; Endoscopy; Humans; Infections; Necrosis; Nutritional Support; Pancreatic Ducts; Pancreatitis, Acute Necrotizing; Stents; Therapeutic Irrigation
PubMed: 31313686
DOI: 10.1097/MOG.0000000000000564 -
The Lancet. Gastroenterology &... Aug 2017Pancreaticobiliary maljunction is a congenital malformation in which the pancreatic and bile ducts join outside the duodenal wall, usually forming a long common channel.... (Review)
Review
Pancreaticobiliary maljunction is a congenital malformation in which the pancreatic and bile ducts join outside the duodenal wall, usually forming a long common channel. Because the action of the sphincter of Oddi does not regulate the function of the pancreaticobiliary junction in patients with pancreaticobiliary maljunction, two-way regurgitation occurs. Reflux of pancreatic juice into the biliary tract is associated with a high incidence of biliary cancer. Biliary carcinogenesis in patients with pancreaticobiliary maljunction is thought to follow the hyperplasia, dysplasia, then carcinoma sequence due to chronic inflammation caused by pancreatobiliary reflux. Pancreaticobiliary maljunction is diagnosed when an abnormally long common channel is evident on imaging studies. Congenital biliary dilatation involves both local dilatation of the extrahepatic bile duct, including the common bile duct, and pancreaticobiliary maljunction. Extrahepatic bile duct resection is the standard surgery for congenital biliary dilatation. However, complete excision of the intrapancreatic bile duct and removal of stenoses of the hepatic ducts are necessary to prevent serious complications after surgery.
Topics: Biliary Tract; Biliary Tract Neoplasms; Common Bile Duct; Dilatation, Pathologic; Humans; Pancreatic Ducts
PubMed: 28691687
DOI: 10.1016/S2468-1253(17)30002-X