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Journal of Digestive Diseases Dec 2022Pancreatic duct stenting using endoscopy or surgery is widely used for the management of benign and malignant pancreatic diseases. Endoscopic pancreatic stents are... (Review)
Review
Pancreatic duct stenting using endoscopy or surgery is widely used for the management of benign and malignant pancreatic diseases. Endoscopic pancreatic stents are mainly used to relieve pain caused by chronic pancreatitis and pancreas divisum, and to treat pancreatic duct disruption and stenotic pancreaticointestinal anastomosis after surgery. They are also used to prevent postendoscopic retrograde cholangiopancreatography pancreatitis and postoperative pancreatic fistula, treat pancreatic cancer, and locate radiolucent stones. Recent advances in endoscopic techniques, such as endoscopic ultrasonography and balloon enteroscopy, and newly designed stents have broadened the indications for pancreatic duct stenting. In this review we outlined the types, insertion procedures, efficacy, and complications of endoscopic pancreatic duct stent placement, and summarized the applications of pancreatic duct stents in surgery.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Pancreas; Pancreatic Ducts; Pancreatitis; Stents; Postoperative Complications
PubMed: 36776138
DOI: 10.1111/1751-2980.13158 -
Pancreatology : Official Journal of the... Sep 2020Disconnected Pancreatic Duct Syndrome (DPDS) is an important but often overlooked complication of acute necrotising pancreatitis (ANP) that occurs due to necrosis of the... (Review)
Review
Disconnected Pancreatic Duct Syndrome (DPDS) is an important but often overlooked complication of acute necrotising pancreatitis (ANP) that occurs due to necrosis of the main pancreatic duct (PD). This segmental necrosis leads on to disconnection between the viable upstream pancreatic parenchyma and the duodenum. The disconnected and functional segment of pancreas continues to secrete pancreatic juice that is not drained into the gastrointestinal tract and lead on to recurrent pancreatic fluid collections (PFC), refractory external pancreatic flstulae and chronic abdominal pain/recurrent pancreatitis. Because of lack of awareness of this important complication of ANP, the diagnosis of DPDS is usually delayed. The delay in diagnosis increases the morbidity of the disease as well as increase the cost of treatment and duration of hospital stay. Surgery has remained the cornerstone for management of patients with DPDS. The conventional surgical approaches have been either resection or internal drainage procedures. Surgery for DPDS in the setting of ANP is often difficult due to presence of local inflammation and extensive venous collaterals in the operative field due to splenic vein thrombosis and therefore is associated with significant morbidity. Advancement in therapeutic endoscopy, especially advent of therapeutic endoscopic ultrasound has opened an exciting new field of minimally invasive therapeutic options for management of DPDS. The present review discusses the current understanding of the clinical manifestations, imaging features and management strategies in patients with DPDS.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Magnetic Resonance Imaging; Pancreatic Diseases; Pancreatic Ducts; Ultrasonography
PubMed: 32800651
DOI: 10.1016/j.pan.2020.07.402 -
Best Practice & Research. Clinical... 2022Endoscopic drainage requires transpapillary access to the pancreatic duct during ERCP. When ERCP failed, EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous... (Review)
Review
Endoscopic drainage requires transpapillary access to the pancreatic duct during ERCP. When ERCP failed, EUS-guided pancreatico-gastro or bulbostomy and/or rendez-vous technique offers an alternative to surgery. Although data has demonstrated that the procedure can be safe and effective, EUS-guided PD drainage remains one of the most technically challenging therapeutic EUS interventions, as evidenced by the multiple considerations on device selection and the risk of severe complications.
Topics: Humans; Endosonography; Ultrasonography, Interventional; Pancreatic Ducts; Cholangiopancreatography, Endoscopic Retrograde; Drainage
PubMed: 36577534
DOI: 10.1016/j.bpg.2022.101815 -
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 -
Gastrointestinal Endoscopy Nov 2022
Topics: Humans; Pancreatic Ducts; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 35931140
DOI: 10.1016/j.gie.2022.07.023 -
Expert Review of Gastroenterology &... Feb 2022In patients with acute necrotizing pancreatitis (ANP), parenchymal necrosis may involve the pancreatic duct, isolating a segment of the pancreas that remains functional... (Review)
Review
INTRODUCTION
In patients with acute necrotizing pancreatitis (ANP), parenchymal necrosis may involve the pancreatic duct, isolating a segment of the pancreas that remains functional but drains its secretions into the peripancreatic fluid collections, leading to disconnected pancreatic duct syndrome (DPDS). DPDS is an important complication of ANP associated with long-term morbidity and mortality. Unfortunately, this critical entity is under-recognized by radiologists. Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for diagnosing and treating such patients. However, considering the invasiveness of the ERCP, a noninvasive diagnosis based on radiological tests is desirable. Radiological literature concerning the diagnosis of DPDS is scarce, and there is substantial ambiguity regarding the radiological definitions of DPDS.
AREAS COVERED
Considering the scarcity of published literature regarding the reliable radiologic diagnosis of DPDS, we performed a thorough review of the existing literature to identify definitions and features of this entity on computed tomography (CT) and magnetic resonance imaging (MRI).
EXPERT OPINION
Existing literature regarding radiologic diagnosis of DPDS was reviewed and analyzed and a comprehensive imaging definition of DPDS was proposed.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Magnetic Resonance Imaging; Pancreatic Ducts; Pancreatitis, Acute Necrotizing; Syndrome; Tomography, X-Ray Computed
PubMed: 35051345
DOI: 10.1080/17474124.2022.2031978 -
Pancreas Apr 2009The formation of the pancreatic duct system is the result of the fusion of 2 embryonic buds, the ventral and dorsal primordia. Frequently, this fusion process is...
OBJECTIVES
The formation of the pancreatic duct system is the result of the fusion of 2 embryonic buds, the ventral and dorsal primordia. Frequently, this fusion process is localized in the pancreatic head; variations, however, may account for the structural diversity of the duct system. Pancreatic duct anomalies and diversity of body and tail are thought to be casuistic.
METHODS
Ninety-nine consecutive adult autopsies with reference to macroscopic anomalies in the distal part of the gland were evaluated. Pancreatograms were performed after large duodenal papilla cannulation. Ducts parallel to gland axis with a diameter of at least one third of the main pancreatic duct at the junction point and aberrant duct with different shapes and/or abnormal third-degree ductuli architecture were noted.
RESULTS
Our study revealed a 9.9% frequency of main pancreatic duct diversity in the pancreatic corpus and tail. Eleven atypical ducts were visible, 9 cranially and 2 caudally from the main pancreatic duct.
CONCLUSIONS
The pancreatic duct system in the body and the tail presents abnormal configuration not described in the past.
Topics: Adult; Aged; Aged, 80 and over; Ampulla of Vater; Catheterization; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatitis; Radiography
PubMed: 19066495
DOI: 10.1097/MPA.0b013e31819081ba -
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 -
Journal of Hepato-biliary-pancreatic... Apr 2023
Topics: Humans; Pancreatic Ducts; Pancreas
PubMed: 36321196
DOI: 10.1002/jhbp.1261 -
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