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Mangiavillano B, Lakhtakia S, Samanta J, Auriemma F, Vargas-Madrigal J, Arcidiacono PG, Barbera C, Ashhab H, Song TJ, Pham KDK, Teoh AYB, Moon JH, Crinò SF, Kongkam P, Aragona G, De Lusong MA, Dhar J, Ofosu A, Ventra A, Paduano D, Franchellucci G, Repici A, Larghi A, Facciorusso A. Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study. Endoscopy 2024; 56:249-257. [PMID: 38237633 DOI: 10.1055/a-2219-3179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic fluid collections (PFCs) using the Hot-Axios device has recently been associated with a significant risk of bleeding. This adverse event (AE) seems to occur less frequently with the use of a different device, the Spaxus stent. The aim of the current study was to compare the rates of bleeding between the two stents. METHODS Patients admitted for treatment of PFCs by EUS plus lumen-apposing metal stent in 18 endoscopy referral centers between 10 July 2019 and 28 February 2022 were identified and their outcomes compared using a propensity-matching analysis. RESULTS 363 patients were evaluated. After a 1-to-1 propensity score match, 264 patients were selected (132 per group). The technical and clinical success rates were comparable between the two groups. Significantly more bleeding requiring transfusion and/or intervention occurred in the Hot-Axios group than in the Spaxus group (6.8% vs. 1.5%; P = 0.03); stent type was a significant predictor of bleeding in both univariate and multivariate regression analyses (P = 0.03 and 0.04, respectively). Bleeding necessitating arterial embolization did not however differ significantly between the two groups (3.0% vs. 0%; P = 0.12). In addition, the Hot-Axios was associated with a significantly higher rate of overall AEs compared with the Spaxus stent (9.8% vs. 3.0%; P = 0.04). CONCLUSION Our study showed that, in patients with PFCs, bleeding requiring transfusion and/or intervention occurred significantly more frequently with use of the Hot-Axios stent than with the Spaxus stent, although this was not the case for bleeding requiring embolization.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy, Humanitas Mater Domini, Castellanza, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Jayanta Samanta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jorge Vargas-Madrigal
- Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Istituto Scientifico Universitario San Raffaele, Milano, Italy
| | - Carmelo Barbera
- Gastroenterology Unit, Civil Hospital Giuseppe Mazzini, Teramo, Italy
| | - Hazem Ashhab
- Gastroenterology, Ahli Hospital, Hebron, Palestine, State of
| | - Tae Jun Song
- Gastroenterology, Asan Medical Center, Songpa-gu, Korea (the Republic of)
| | - Khanh Do-Kong Pham
- Bergen Research group for Gastrointestinal Endoscopy (BRAGE), Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anthony Y B Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Jong Ho Moon
- Internal Medicine, Soon Chung Hyang University School of Medicine, Bucheon, Korea (the Republic of)
| | | | - Pradermchai Kongkam
- Division of Hospital and Ambulatory Medicine, and Pancreas Research Unit, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Giovanni Aragona
- Internal Medicine, Gastroenterology and Hepatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Mark A De Lusong
- Interventional Endoscopy, University of the Philippines Manila, Manila, Philippines
| | - Jahnvi Dhar
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, United States
| | - Agostino Ventra
- Gastroenterology, Azienda Ospedaliera Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy, Humanitas Mater Domini, Castellanza, Italy
| | | | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Antonio Facciorusso
- Gastroenterology, University of Foggia Department of Medical and Surgical Sciences, Foggia, Italy
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Mangiavillano B, Moon JH, Facciorusso A, Vargas-Madrigal J, Di Matteo F, Rizzatti G, De Luca L, Forti E, Mutignani M, Al-Lehibi A, Paduano D, Bulajic M, Decembrino F, Auriemma F, Franchellucci G, De Marco A, Gentile C, Shin IS, Rea R, Massidda M, Calabrese F, Mirante VG, Ofosu A, Crinò SF, Hassan C, Repici A, Larghi A. Endoscopic ultrasound-guided gallbladder drainage as a first approach for jaundice palliation in unresectable malignant distal biliary obstruction: Prospective study. Dig Endosc 2024; 36:351-358. [PMID: 37253185 DOI: 10.1111/den.14606] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in patients with distal malignant biliary obstruction (DMBO). Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. In a palliative setting the endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) could represent an easy and valid option. We performed a prospective study with a new EC-LAMS with the primary aim to assess the clinical success rate of EUS-GBD as a first-line approach to the palliation of DMBO. METHODS In all, 37 consecutive patients undergoing EUS-GBD with a new EC-LAMS were prospectively enrolled. Clinical success was defined as bilirubin level decrease >15% within 24 h and >50% within 14 days after EC-LAMS placement. RESULTS The mean age was 73.5 ± 10.8 years; there were 17 male patients (45.9%). EC-LAMS placement was technically feasible in all patients (100%) and the clinical success rate was 100%. Four patients (10.8%) experienced adverse events, one bleeding, one food impaction, and two cystic duct obstructions because of disease progression. No stent-related deaths were observed. The mean hospitalization was 7.7 ± 3.4 days. Median overall survival was 4 months (95% confidence interval 1-8). CONCLUSION Endoscopic ultrasound-guided gallbladder drainage with the new EC-LAMS is a valid option in palliative endoscopic biliary drainage as a first-step approach in low survival patients with malignant jaundice unfit for surgery. A smaller diameter EC-LAMS should be preferred, particularly if the drainage is performed through the stomach, to avoid potential food impaction, which could result in stent dysfunction.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | | | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Abed Al-Lehibi
- King Fahad Medical City, Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
| | - Milutin Bulajic
- Digestive Endoscopy, Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Francesco Decembrino
- UOC Gastroenterologia ed Endoscopia Digestiva, Ente Ecclesiastico-Ospedale Generale Regionale "F.Miulli", Bari, Italy
| | | | - Gianluca Franchellucci
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro De Marco
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Varese, Italy
| | - Il Sang Shin
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea
| | - Roberta Rea
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Vincenzo Giorgio Mirante
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, USA
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Brandaleone L, Franchellucci G, Facciorusso A, Samanta J, Moon JH, Vargas-Madrigal J, Robles Medranda C, Barbera C, Di Matteo F, Bulajic M, Auriemma F, Paduano D, Calabrese F, Gentile C, Massidda M, Bianchi M, De Luca L, Polverini D, Masoni B, Poletti V, Marcozzi G, Hassan C, Repici A, Mangiavillano B. The Use of a New Dedicated Electrocautery Lumen-Apposing Metal Stent for Gallbladder Drainage in Patients with Acute Cholecystitis. Diagnostics (Basel) 2023; 13:3341. [PMID: 37958236 PMCID: PMC10650170 DOI: 10.3390/diagnostics13213341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.
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Affiliation(s)
- Luca Brandaleone
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Gianluca Franchellucci
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Biomedical Science, Foggia University Hospital, 71122 Foggia, Puglia, Italy;
| | - Jayanta Samanta
- Gastroenterology PGIMER, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon 31538, Republic of Korea;
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia 50101, Costa Rica;
| | - Carlos Robles Medranda
- Instituto Ecuatoriano de Enfermedades Digestivas—IECED, Gastroenterology Av Abel Romero Castillo, Guayaquil 090505, Guayas, Ecuador;
| | - Carmelo Barbera
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Rome, Italy;
| | - Francesco Di Matteo
- GIUnit, Digestive Diseases, Campus Bio Medico University, 00128 Rome, Rome, Italy;
| | - Milutin Bulajic
- Digestive Endoscopy, Fatebenefratelli Isola Tiberina—Gemelli Isola, 00186 Rome, Rome, Italy;
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Federica Calabrese
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
| | - Marco Massidda
- Gastroenterology and Digestive Endoscopy Unit, Mater Olbia Hospital, 07026 Olbia, Sassari, Italy;
| | - Marco Bianchi
- Policlinico Casilino Hospital, 00169 Rome, Rome, Italy;
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, 20142 Milan, Milan, Italy;
| | - Davide Polverini
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Benedetta Masoni
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Valeria Poletti
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Giacomo Marcozzi
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Cesare Hassan
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy; (D.P.); (B.M.); (V.P.); (G.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Benedetto Mangiavillano
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
- Gastrointestinal Endoscopy Unit—Humanitas Mater Domini, 21100 Castellanza, Varese, Italy; (F.A.); (D.P.); (F.C.); (C.G.)
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Mangiavillano B, Larghi A, Vargas-Madrigal J, Facciorusso A, Di Matteo F, Crinò SF, Pham KDC, Moon JH, Auriemma F, Camellini L, Paduano D, Stigliano S, Calabrese F, Ofosu A, Al-Lehibi A, Repici A. EUS-guided gastroenterostomy using a novel electrocautery lumen apposing metal stent for treatment of gastric outlet obstruction (with video). Dig Liver Dis 2023; 55:644-648. [PMID: 36890050 DOI: 10.1016/j.dld.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for the treatment of gastric outlet obstruction (GOO) has been actually performed only with one type of electrocautery lumen-apposing metal stents (EC-LAMS). We aimed to evaluate the safety, technical and clinical effectiveness of EUS-GE using a newly available EC-LAMS in patients with malignant and benign GOO. MATERIALS AND METHODS Consecutive patients who underwent EUS-GE for GOO using the new EC-LAMS at five endoscopic referral centers were retrospectively evaluated. Clinical efficacy was determined utilizing the Gastric Outlet Obstruction Scoring System (GOOSS). RESULTS Twenty-five patients (64% male, mean age 68.7 ± 9.3 years) met the inclusion criteria; 21 (84%) had malignant etiology. Technically, EUS-GE was successful in all patients, with a mean procedural time of 35 ± 5 min. Clinical success was 68% at 7 days and 100% at 30 days. The mean time to resume oral diet was 11.4 ± 5.8 h, with an improvement of at least one point of GOOSS score observed in all patients. The median hospital stay was 4 days. No procedure-related adverse events occurred. After a mean follow-up of 7.6 months (95% CI 4.6-9.2), no stent dysfunctions were observed. CONCLUSION This study suggests EUS-GE can be performed safely and successfully using the new EC-LAMS. Future large multicenter prospective studies are needed to confirm our preliminary data.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit - Humanitas Mater Domini, Castellanza, VA, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Jong Hoo Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit - Humanitas Mater Domini, Castellanza, VA, Italy
| | | | - Danilo Paduano
- Gastrointestinal Endoscopy Unit - Humanitas Mater Domini, Castellanza, VA, Italy
| | | | - Federica Calabrese
- Gastrointestinal Endoscopy Unit - Humanitas Mater Domini, Castellanza, VA, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abed Al-Lehibi
- King Fahad Medical City- Faculty of Medicine, King Saud Bin Abduaziz University-Health Science, Riyadh, Saudi Arabia
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
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Madrigal Méndez AL, Grant D, Hernández V, Ernest-Suárez K, Vargas-Madrigal J, Arguedas LD, Villalobos Á. Management of multiple esophageal leaks with an ultra-large fully covered metallic stent after aborted peroral endoscopic myotomy. Endoscopy 2023; 55:E478-E479. [PMID: 36858346 PMCID: PMC9977564 DOI: 10.1055/a-2018-4213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
| | - Daniela Grant
- Gastroenterology, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Viviana Hernández
- Gastroenterology, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Kenneth Ernest-Suárez
- Gastroenterology, Caja Costarricense de Seguro Social, San José, Costa Rica,University of Costa Rica, Faculty of Sciences, San José, Costa Rica
| | - Jorge Vargas-Madrigal
- Gastroenterology Department, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | | | - Álvaro Villalobos
- Gastroenterology, Caja Costarricense de Seguro Social, San José, Costa Rica
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Vargas-Jiménez J, Vargas-Madrigal J, Arias-Mora R, Ulate-Ovares D, Solis-Ugalde B. Pancreatic Metastasis from Malignant Melanoma: Not All That Glitters Is Gold. Case Rep Gastroenterol 2021; 15:131-136. [PMID: 33708060 PMCID: PMC7923732 DOI: 10.1159/000511864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/18/2020] [Indexed: 01/30/2023] Open
Abstract
Pancreatic adenocarcinoma is the most common malignancy of the pancreas; on rare occasions, metastatic tumors are present. Differentiating a primary neoplasm from a metastatic one is important for ensuring adequate treatment for the patient. We present a case of metastatic melanoma to the pancreas. A 60-year-old man presented with a history of weight loss, vague abdominal pain, jaundice, and pruritus. Laboratory tests showed increased total bilirubin, with a direct fraction predominance, as well as increased alkaline phosphatase and gamma glutamyl transferase. Imaging studies revealed a mass in the head of the pancreas. Endoscopic ultrasound (EUS)-guided fine needle biopsy was performed, and histologic examination confirmed the diagnosis of metastatic melanoma. This case report illustrates the invaluable use of EUS-guided tissue acquisition in the study of pancreatic solid lesions to obtain an accurate diagnosis. Melanomas should always be part of a differential diagnosis when evaluating patients with pancreatic masses.
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Affiliation(s)
- Jose Vargas-Jiménez
- Department of Gastroenterology and Endoscopy, Hospital La Anexión, Nicoya, Costa Rica
| | - Jorge Vargas-Madrigal
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | - Roberto Arias-Mora
- Department of Gastroenterology and Endoscopy, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | - Diana Ulate-Ovares
- Department of Pathology, Hospital Enrique Baltodano Briceño, Liberia, Costa Rica
| | - Bruno Solis-Ugalde
- Department of Radiology, Hospital San Juan de Dios, San José, Costa Rica
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