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World Journal of Gastroenterology Apr 2017The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid... (Review)
Review
The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.
Topics: Drainage; Endoscopy, Digestive System; Humans; Pancreatic Pseudocyst; Stents
PubMed: 28487603
DOI: 10.3748/wjg.v23.i15.2660 -
The Korean Journal of Gastroenterology... May 2022EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The... (Review)
Review
EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The development of dedicated stents and delivery systems for EUS-guided interventions have improved the efficacy and safety of these procedures. Furthermore, the introduction of lumen-apposing metal stents has reduced the complication significantly of endoscopic transmural drainage of pancreatic collections and gallbladder. Recent studies show that EUS-guided drainage of pancreaticobiliary ducts and peripancreatic fluid collection produces good results and low complication rates. This review describes the current position and role of interventional EUS for pancreatobiliary disease in clinical practice.
Topics: Bile Ducts; Drainage; Endosonography; Gallbladder; Humans; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35610550
DOI: 10.4166/kjg.2022.064 -
Revista Do Colegio Brasileiro de... 2023Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the... (Review)
Review
Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the bile tract is imperative. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a choledochal prosthesis is an effective treatment in about 90% of cases, even in experienced hands. In cases of ERCP failure, therapeutic options traditionally include surgical bypass by hepaticojejunostomy (HJ) or percutaneous transparietohepatic drainage (DPTH). In recent years, endoscopic ultrasound-guided biliary drainage techniques have gained space because they are less invasive, effective and have an acceptable incidence of complications. Endoscopic echo-guided drainage of the bile duct can be performed through the stomach (hepatogastrostomy), duodenum (choledochoduodenostomy) or by the anterograde drainage technique. Some services consider ultrasound-guided drainage of the bile duct the procedure of choice in the event of ERCP failure. The objective of this review is to present the main types of endoscopic ultrasound-guided biliary drainage and compare them with other techniques.
Topics: Stents; Endosonography; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Ultrasonography, Interventional
PubMed: 36995833
DOI: 10.1590/0100-6991e-20233414-en -
Gut and Liver Sep 2017In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the... (Review)
Review
In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery. However, an endoscopic "step up" approach in the management of pancreatic walled-off necrosis has also been advocated. Both endoscopic and percutaneous drainage routes may be used depending on the anatomical location of the collections. New-generation large diameter EUS-specific stent systems have also recently been described. The device allows precise and effective drainage of the collections and permits endoscopic necrosectomy through the stents.
Topics: Acute Disease; Drainage; Endosonography; Gastrostomy; Humans; Necrosis; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Stents
PubMed: 28494574
DOI: 10.5009/gnl16178 -
Saudi Journal of Gastroenterology :... 2019Endoscopic transpapillary or transanastomotic pancreatic duct drainage (PD) is the mainstay of drainage in symptomatic pancreatic duct obstruction or leakage. However,... (Review)
Review
Endoscopic transpapillary or transanastomotic pancreatic duct drainage (PD) is the mainstay of drainage in symptomatic pancreatic duct obstruction or leakage. However, transpapillary or transanastomotic PD can be technically difficult due to the tight stricture or surgically altered anatomy (SAA), and endoscopic ultrasound (EUS)-guided PD (EUS-PD) is now increasingly used as an alternative technique. There are two approaches in EUS-PD: EUS-guided rendezvous (EUS-RV) and EUS-guided transmural drainage (EUS-TMD). In cases with normal anatomy, EUS-RV should be the first approach, whereas EUS-TMD can be selected in cases with SAA or duodenal obstruction. In our literature review, technical success and adverse event rates were 78.7% and 21.8%, respectively. The technical success rate of EUS-RV appeared lower than EUS-TMD due to the difficulty in guidewire passage. In future, development of dedicated devices and standardization of EUS-PD procedure are necessary.
Topics: Drainage; Endosonography; Humans; Pancreatic Diseases; Pancreatic Ducts; Surgery, Computer-Assisted
PubMed: 30632484
DOI: 10.4103/sjg.SJG_474_18 -
World Journal of Gastroenterology Jun 2020The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or... (Review)
Review
The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.
Topics: Drainage; Endoscopy; Endosonography; Fluoroscopy; Gastrointestinal Diseases; Humans; Stents
PubMed: 32550749
DOI: 10.3748/wjg.v26.i21.2715 -
Journal of Visceral Surgery Apr 2018The use of surgical drains is the subject of much debate but they continue to be commonly used. The phenomenon of drain migration from their desired position following...
INTRODUCTION
The use of surgical drains is the subject of much debate but they continue to be commonly used. The phenomenon of drain migration from their desired position following surgery has not been studied. The aim of this study was to evaluate the incidence of the displacement of surgical drains among patients undergoing abdominal gastrointestinal surgery.
PATIENTS AND METHODS
We performed a review of all patients who underwent an early CT-scan postoperatively after abdominal gastrointestinal surgery prior to drain mobilization, between January 2013 and April 2016 in the Dijon University Hospital Center. Pre-and intra-operative data (number, type and position of drains) and postoperative data (imaging and evolution) were collected retrospectively.
RESULTS
This study included 125 patients. Thirty-five (28%) were found to have a displacement of at least one drain from its original position. Forty-one (19.8%) of the 207 studied drains had moved. Postoperative morbidity was not higher in patients with displaced drains (P=0.51). None of all the studied preoperative and operative factors have been found to be a risk factor for drain displacement.
CONCLUSION
Surgical drains displacement is frequently encountered in patients undergoing digestive abdominal surgery. In our experience, this phenomenon does not seem to have any clinical implications. When a benefit is expected from the use of surgical drains, intraperitoneal fixation appears to be necessary.
Topics: Age Factors; Aged; Cohort Studies; Device Removal; Digestive System Surgical Procedures; Drainage; Female; Foreign-Body Migration; France; Hospitals, University; Humans; Incidence; Length of Stay; Male; Middle Aged; Peritoneal Cavity; Prognosis; Retrospective Studies; Risk Assessment; Sex Factors; Tomography, X-Ray Computed
PubMed: 29102315
DOI: 10.1016/j.jviscsurg.2017.10.001 -
Chirurgia (Bucharest, Romania : 1990) 2018Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are... (Review)
Review
Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's general state and comorbidities. Thus, a therapeutical algorithm may be of great use in choosing the most feasible technique for the diagnosed lesion that is also patient-adapted.
Topics: Diagnosis, Differential; Drainage; Humans; Pancreatectomy; Pancreatic Pseudocyst; Pancreatitis; Risk Factors; Treatment Outcome
PubMed: 29981666
DOI: 10.21614/chirurgia.113.3.353 -
World Journal of Gastroenterology Apr 2016Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In... (Review)
Review
Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.
Topics: Cholestasis; Drainage; Endosonography; Gastrostomy; Humans; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 27099437
DOI: 10.3748/wjg.v22.i15.3945 -
The Korean Journal of Gastroenterology... Sep 2018Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery... (Review)
Review
Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis; Treatment Outcome
PubMed: 30270591
DOI: 10.4166/kjg.2018.72.3.97