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Park J, Han K, Kwon JH, Kim MD, Won JY, Moon S, Kim GM. Feasibility of Percutaneous Pancreatic Stent Placement in Postoperative Pancreaticojejunostomy Stenosis. Korean J Radiol 2023; 24:1241-1248. [PMID: 38016683 DOI: 10.3348/kjr.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To evaluate the role of percutaneous pancreatic stent placement in postoperative pancreaticojejunostomy stenosis (PJS). MATERIALS AND METHODS This retrospective single-center study included seven procedures in five patients (four males and one female; median age, 63 years) who underwent percutaneous pancreatic stent placement for postoperative PJS between January 2005 and December 2021. The patients were referred to interventional radiology because of unfavorable anatomy or bowel abnormalities. The pancreatic duct was accessed under ultrasound and/or computed tomography guidance. A stent was placed after balloon dilatation of the PJS. Moreover, plastic stents were placed for the first two procedures, whereas bare-metal stents were used for the remaining five procedures. Technical success was defined as the successful placement of stents for the PJS, meanwhile, clinical success was defined as the normalization of pancreatic enzymes without recurrence of pancreatitis. RESULTS Pancreatic duct access and stent placement were successfully performed in all patients (technical success rate: 100%). All the procedures initially yielded clinical success. However, recurrence of pancreatitis was observed after two procedures that used plastic stents because of stent migration at 0.3 and 3 months after the procedure. In contrast, no instances of recurrent pancreatitis were noted after metal stent placement for a follow-up duration of 1-36 months. No serious procedure-related adverse events were observed. CONCLUSION Percutaneous pancreatic stent placement may be a viable option for patients with postoperative PJS in whom an endoscopic approach is not feasible. Metal stents may be considered over plastic stents for the management of PJS, considering the possible lower stent migration and infeasibility of frequent endoscopic stent exchange due to the altered anatomy.
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Affiliation(s)
- Juil Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungmo Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Efficacy and Safety of Peroral Pancreatoscopy Through the Fistula Created by Endoscopic Ultrasound-Guided Pancreaticogastrostomy. Pancreas 2022; 51:228-233. [PMID: 35584379 DOI: 10.1097/mpa.0000000000002003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Endoscopic ultrasound/endosonography-guided pancreaticogastrostomy (EUS-PGS) is a useful alternative when endoscopic retrograde pancreatography is difficult. Recently, many procedures, including peroral pancreatoscopy (POPS), have been performed through the mature fistula (MF) created by EUS-PGS. We evaluate the efficacy and safety of POPS to diagnose and treat pancreatic ductal stricture/pancreato-jejunal anastomotic stricture (PDS/PJAS) through the MF. METHODS Twenty patients underwent EUS-PGS; 13 of these underwent POPS through the MF at Juntendo University Hospital. All patients were studied retrospectively in terms of technical and clinical success rates and adverse events (AEs). RESULTS The technical and clinical success rates of EUS-PGS were 95% and 100%. The early and late AEs rates were 20% and 15%. The technical success rate of POPS was 100%, with one AE. Biopsy of PDS/PJAS under POPS guidance revealed recurrent/residual intrapapillary mucinous adenoma (3 patients) and benign fibrotic stricture (10 patients). In the latter patients, multiple plastic stents were placed to dilate PDS/PJAS. Four patients with improvement of PDS/PJAS were stent free, but the remaining patients were not yet. CONCLUSIONS Endoscopic ultrasound/endosonography-guided pancreaticogastrostomy and various procedures (including POPS) performed through the MF are feasible and effective and can diagnose and treat PDS/PJAS with acceptable AEs rates.
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Percutaneous catheter drainage of pancreatic associated pathologies: A systematic review and meta-analysis. Eur J Radiol 2021; 144:109978. [PMID: 34607289 DOI: 10.1016/j.ejrad.2021.109978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The main goal of this systematic review was to assess the technical and clinical success, adverse events (AEs), surgery, and overall mortality proportion after percutaneous catheter drainage (PCD) of two pancreatic lesions. METHODS An extant search in online databases including Scopus, PubMed (Medline), Embase (Elsevier), Web of Science, Cochrane library, and Google Scholar, was conducted to recognize all studies that used PCD intervention in the management of pancreatic necrosis (PN) and pancreatic pseudocysts (PP). Random effects meta-analysis was performed, and Cochrane's Q test and I2statistic were utilized to determine heterogeneity. In addition, meta-regression was used to explore the influence of categorical variables on heterogeneity. RESULTS Thirty-two studies (1398 patients) including PN in 26 (1256 cases, 89.8%) studies and PP in 6 (142 cases, 10.2%) studies were identified. Technical success proportion was 100% (95% confidence interval [CI] 100%-100%, I2: 0.0%), clinical success 63% (95% CI 55%-71%, I2: 92.9%), AEs 26% (95% CI 21%-31%, I2: 78%), surgery after PCD intervention 33% (95% CI 25%-40%, I2: 92.4%), and overall mortality was 13% (95% CI 9%-17%, I2: 82.8%). The most common ADs after PCD intervention were development of fistula (106, 42.6%), hemorrhage (44, 17.7%), sepsis (40, 16.1%). CONCLUSION A significant clinical success proportion with low AEs, surgery, and overall mortality proportion after PCD intervention was found, although the results should be interpreted with caution due to the high heterogeneity.
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Image-Guided Percutaneous Pancreatic Duct Drainage: A 10-Year Observational Study. J Vasc Interv Radiol 2021; 32:1075-1080.e2. [PMID: 33857612 DOI: 10.1016/j.jvir.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To study the safety, efficacy, and long-term outcomes of percutaneous pancreatic duct drainage (PPDD) for treating pancreatic duct (PD) obstruction. MATERIALS AND METHODS This prospective observational cohort study included 73 patients with PD obstruction between December 2010 and June 2020. Patients underwent PPDD under ultrasound and fluoroscopy guidance, computed tomography (CT) and fluoroscopy guidance, or CT guidance only. They were categorized into 2 groups: nonmalignant (26 patients with PD obstruction due to acute and chronic pancreatitis or postoperative stricture) and malignant (47 patients with pancreatic head and ampullary tumors). RESULTS The overall technical success rate was 98.6% (72/73). No major complications were encountered; however, severe weakness, lack of appetite, and tachycardia were observed in 4.1% (3/73) of patients, managed with intravenous resuscitation. Multivariate analysis demonstrated that diagnosis type (pancreatic head tumor: P = .049; odds ratio = 1.95 [1.11-2.25], and chronic pancreatitis: P = .048; odds ratio = 6.25 [1.74-22.22]) was associated with mortality. The median survival time was 16.3 months. Moreover, 15.1% (11/73) of the patients were alive 4 years after the PPDD procedure, and the mean overall survival time of nonmalignant and malignant patients was 35.1 and 21.4 months, respectively. CONCLUSIONS Image-guided PPDD appears to be feasible and safe and provides a valuable therapeutic option for managing patients with PD obstruction.
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Toshima T, Fujimori N, Yoshizumi T, Itoh S, Nagao Y, Harada N, Oono T, Mori M. A Novel Strategy of Endoscopic Ultrasonography-Guided Pancreatic Duct Drainage for Pancreatic Fistula After Pancreaticoduodenectomy. Pancreas 2021; 50:e21-e22. [PMID: 33565808 DOI: 10.1097/mpa.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Masaryk V, Will U, Fueldner F, Meyer F. Management of a postoperative fistula after pancreatic left resection using percutaneous endoscopy-assisted transpapillary pancreatic duct drainage via its stump. VideoGIE 2021; 6:172-175. [PMID: 33898894 PMCID: PMC8058273 DOI: 10.1016/j.vgie.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Viliam Masaryk
- Department of Gastroenterology, Hepatology and General Internal Medicine, Municipal Hospital ("SRH Wald-Klinikum Gera GmbH"), Gera, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology and General Internal Medicine, Municipal Hospital ("SRH Wald-Klinikum Gera GmbH"), Gera, Germany
| | - Frank Fueldner
- Department of Gastroenterology, Hepatology and General Internal Medicine, Municipal Hospital ("SRH Wald-Klinikum Gera GmbH"), Gera, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
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Aljoqiman KS, Han K, Park SW, Kim MD. Percutaneous Stent Placement for Pancreatic Duct Stricture in a Patient with Previous Gastric and Pancreatic Surgery. J Vasc Interv Radiol 2020; 31:1952-1954. [PMID: 33012650 DOI: 10.1016/j.jvir.2020.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Khalid Suliman Aljoqiman
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea; Department of Radiology, King Faisal University College of Medicine, Alhasa, Saudi Arabia
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
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Kamo M, Miyazawa R, Nisiyama T, Nakamura K, Yagihashi K. Percutaneous transgastric pancreatic duct drainage for pancreaticojejunal leak after pancreaticoduodenectomy. ACTA ACUST UNITED AC 2020; 25:471-472. [PMID: 31650965 DOI: 10.5152/dir.2019.19038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pancreaticojejunal anastomotic leakage is one of the severe complications after pancreaticoduodenectomy and is often difficult to manage. A 64-year-old man status post pancreaticoduodenectomy had the gastroduodenal artery stump bleeding caused by the pancreaticojejunal anastomotic leakage, successfully treated by placing a covered stent. To control the leakage, subsequent percutaneous transgastric pancreatic duct puncture was performed under fluoroscopic guidance, targeting a surgically placed pancreaticojejunal internal drainage catheter. A 5 F catheter with side holes was inserted into the main pancreatic duct, the tip of which was placed in the anastomosed jejunum. The leak was successfully treated using this catheter. Percutaneous transgastric pancreatic duct drainage might be a useful and feasible option to resolve the condition.
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Affiliation(s)
- Minobu Kamo
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan; Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ryo Miyazawa
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoya Nisiyama
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Kunihiro Yagihashi
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan; Department of Radiology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
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Ogura T, Ohama H, Higuchi K. Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention. Clin Endosc 2019; 53:429-435. [PMID: 31771320 PMCID: PMC7403024 DOI: 10.5946/ce.2019.130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/28/2019] [Indexed: 12/16/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided pancreatic access is an emergent method that can be divided into the two main techniques of EUS-guided rendezvous and pancreatic transmural stenting (PTS). While many reports have described EUS-guided procedures, the indications, technical tips, clinical effects, and safety of EUS-guided pancreatic duct drainage (EUS-PD) remain controversial. This review describes the current status of and problems associated with EUS-PD, particularly PTS. We reviewed clinical data derived from a total of 334 patients. Rates of technical and clinical success ranged from 63% to 100% and 76% to 100%, respectively. In contrast, the rate of procedure-related adverse events was high at 26.7% (89/334). The most frequent adverse events comprised abdominal pain (n=38), acute pancreatitis (n=15), bleeding (n=9), and issues associated with pancreatic juice leakage such as perigastric fluid, pancreatic fluid collection, or pancreatic juice leaks (n=8). In conclusion, indications for EUS-PTS are limited, as is the evidence of its viability, due to the scarcity of expert operators. Despite improvements made to various devices, EUS-PTS remains technically challenging. Therefore, a long-term, large-scale, multicenter study is required to establish this technique as a viable alternative drainage method.
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Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Hideko Ohama
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Krafft MR, Nasr JY. Anterograde Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: A Technical Review. Dig Dis Sci 2019; 64:1770-1781. [PMID: 30734236 DOI: 10.1007/s10620-019-05495-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/24/2019] [Indexed: 12/27/2022]
Abstract
The advancement of pancreatic endotherapy has increased the availability of minimally invasive endoscopic pancreatic ductal drainage techniques. In this regard, familiarity with endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is critical for treatment of obstructed pancreatic ductal systems, especially in nonsurgical candidates and in patients desiring a minimally invasive approach. Two distinct forms of EUS-PDD exist, viz. rendezvous-assisted endoscopic retrograde pancreatography (rendezvous-assisted ERP) and anterograde EUS-PDD. Anterograde EUS-PDD refers to transmural anterograde passage of a pancreatic drainage catheter or stent directly into the main pancreatic duct, through either the gastric or enteral wall. Rendezvous-assisted ERP should be attempted after failed conventional ERP, and anterograde EUS-PDD should be considered if rendezvous-assisted ERP fails or is not technically feasible. Common clinical scenarios that fulfil these conditions are chronic pancreatitis with high-grade main pancreatic duct obstruction, surgically altered anatomy with ductal/anastomotic obstruction, pancreas divisum, and disconnected pancreatic duct syndrome. The focus of this review article is anterograde EUS-PDD and its indications, technique, and outcomes. It also provides a summary of our own experience with this procedure, and a video demonstration of the technique.
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Affiliation(s)
- Matthew R Krafft
- Section of Digestive Diseases, West Virginia University Medicine, PO Box 9161, One Medical Center Drive, Morgantown, WV, 26506-9161, USA
| | - John Y Nasr
- Section of Digestive Diseases, West Virginia University Medicine, PO Box 9161, One Medical Center Drive, Morgantown, WV, 26506-9161, USA.
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