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Jeropoulos RM, Joshi D, Aldeiri B, Davenport M. Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience. Children (Basel) 2024; 11:74. [PMID: 38255387 PMCID: PMC10813922 DOI: 10.3390/children11010074] [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] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.
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Affiliation(s)
- Renos M. Jeropoulos
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Deepak Joshi
- Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK;
| | - Bashar Aldeiri
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, London SE5 9RS, UK
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Giri S, Bhrugumalla S, Gangadhar S, Angadi S. Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis. Acta Gastroenterol Belg 2024; 87:1-5. [PMID: 38431784 DOI: 10.51821/87.1.12118] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background Endoscopic ultrasound (EUS)-guided cystogastrostomy is the treatment of choice for managing symptomatic pancreatic fluid collections (PFC). However, studies on the number of stents for optimal drainage of PFCs are limited. Hence, the present study was conducted to compare the outcome of single versus two double-pigtail stents for endoscopic drainage of PFCs. Methods This is a single-center, retrospective analysis of patients undergoing endoscopic drainage of PFCs with minimal necrosis (pseudocyst or walled-off necrosis with <30% solid content) at a tertiary center in South India from October 2020 to October 2022. Post-procedure, patients were followed up for clinical improvement, and stents were removed after documentation of cyst size reduction on imaging. Results Sixty-three patients (82.5% males, median age: 34 years) fulfilling the selection criteria were included. For single stent placement (n = 47), stents of size 8.5 Fr or 10 Fr were used, while for placement of two stents (n = 16), 7 Fr stents were used. The technical success rate was 100%. Intraprocedural and early postprocedural adverse events (all mild to moderate) were comparable between the groups (17.0% with single stent vs. 25.0% with two stents, p = NS). Clinical success was achieved in 93.6% of patients, with no difference between both groups. Three patients in the single stent group required additional procedures. All patients underwent successful stent removal after a median follow-up of 14 weeks. Conclusion A single pigtail stent of 8.5 Fr or 10 Fr size for EUSguided cystogastrostomy provides efficacy and safety similar to that of two stents.
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Affiliation(s)
- S Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Bhrugumalla
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Gangadhar
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
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Giri S, Harindranath S, Afzalpurkar S, Angadi S, Sundaram S. Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2023; 16:26317745231199364. [PMID: 37736486 PMCID: PMC10510348 DOI: 10.1177/26317745231199364] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023] Open
Abstract
Background Lumen apposing metal stents (LAMSs) have a higher clinical success rate for managing pancreatic fluid collections. But they are associated with adverse events (AEs) like bleeding, migration, buried stent, occlusion, and infection. It has been hypothesized that placing a double pigtail stent (DPS) within LAMS may mitigate these AEs. The present systematic review and meta-analysis were conducted to compare the outcome and AEs associated with LAMS with or without a coaxial DPS (LAMS-DPS). Methods A comprehensive literature search of three databases from January 2010 to August 2022 was conducted for studies comparing the outcome and AEs of LAMS alone and LAMS-DPS. Pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes. Results Overall, eight studies (n = 460) were included in the final analysis. The clinical success rate (RR 1.00, 95% CI: 0.87-1.14) and the risk of overall AEs (RR 1.60, 95% CI: 0.95-2.68) remained comparable between both groups. There was no difference in the risk of bleeding between LAMS alone and LAMS-DPS (RR 1.80, 95% CI: 0.83-3.88). Individual analysis of other AEs, including infection, stent migration, occlusion, and reintervention, showed no difference in the risk between both procedures. Conclusion The present meta-analysis shows that coaxial DPS within LAMS may not reduce AE rates or improve clinical outcomes. Further larger studies, including patients with walled-off necrosis, are required to demonstrate the benefit of coaxial DPS within LAMS.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davangere, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Room No. 1004, Homi Bhabha Block, Mumbai, Maharashtra 400012, India
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Ibrahim M, Roshdy N, Taleb A, Alfadda A, Al-Lehibi A, Altonbary A, Galal A, El-Fouly A, Kozlowska A, Khor C, Isayama H, Okasha H, Barthet M, Giovannini M, Pausawasdi N, Eisendrath P, Kongkam P, Ratanachu-ek T, Nakai Y. Evaluation of the ex-vivo porcine simulator on EUS-guided cystogastrostomy using lumen-apposing metal stent training. Endosc Ultrasound 2022; 11:201-207. [PMID: 35708369 PMCID: PMC9258017 DOI: 10.4103/eus-d-21-00109] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022] Open
Abstract
Bckground and Objectives EUS-guided cystogastrostomy is a well-established advanced endoscopic technique with a steep-learning curve which necessitates an ex-vivo simulator that would allow for adequate training. The aim of this study is to evaluate the feasibility of the model in allowing training for EUS-guided cystogastrostomy using lumen-apposing metal stent (LAMS). Subjects and Methods The model was created by ROEYA Training Center, Egypt, using native porcine tissue to create fluid collections simulating both cystic and solid lesions. It was designed and tested in advance while the hydrogel was added on-site. The simulator was evaluated prospectively in five training sessions involving 17 international experts. The task was to successfully deploy the LAMS to drain the created cyst. After using the simulator, the experts were asked to fill a questionnaire to assess their experience. The primary endpoint was overall satisfaction with the model as a training tool. Results All of the experts were satisfied with the model as a tool to train endoscopists for the technique. 76.5% (n = 11) of the experts thought the model to be moderately realistic. Proper visualization was reported by 94.1% of the experts. All experts believed the lesions to be either slightly like or very similar to real lesions. The model was graded "easy" in difficulty by 11 of the experts. Conclusions In all parameters assessed, the experts thought the model to be a useful tool for future training. This preliminary study suggests that the aforementioned simulator can be used to train endoscopists on using LAMS in a risk-free environment.
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Affiliation(s)
- Mostafa Ibrahim
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Noran Roshdy
- ROEYA Gastroenterology, Hepatology and Endoscopy Center, Cairo, Egypt
| | | | - Abdulrahman Alfadda
- Department of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abed Al-Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Altonbary
- Department of Gastroenterology and Hepatology, Mansoura University, Egypt
| | - Ahmed Galal
- Department of Gastroenterology, Alexandria Hospital, Egypt
| | - Amr El-Fouly
- Endemic Medicine Department, Helwan University, Egypt
| | - Anna Kozlowska
- Department of Endoscopy, Hospital of Ministry of Internal Affairs, Szczecin, Poland
| | - Christopher Khor
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Hussein Okasha
- Internal Medicine Department, Kasr Al-Ainy School of Medicine, Cairo University, Egypt
| | - Marc Barthet
- Department of Gastroenterology & Hepatology, Hospital Nord, Marseille, France
| | - Marc Giovannini
- Department of Gastroenterology & Hepatology, Paoli Calmettes Institute, Marseille, France
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Pierre Eisendrath
- Department of Hepato-Gastroenterology, Saint-Pierre Hospital, Brussels, Belgium
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Chulalongkom University, Bangkok, Thailand
| | | | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, University of Tokyo, Tokyo, Japan
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Aslam S, Ansari Z, Alani M, Srinivasan I, Chuang KY. Coaxial Double-Pigtail Stent Placement: A Simple Solution to Decrease Bleeding Risk Associated With Lumen-Apposing Metal Stent? Cureus 2021; 13:e15981. [PMID: 34336472 PMCID: PMC8318618 DOI: 10.7759/cureus.15981] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
Endoscopic cystogastrostomy using lumen-apposing metal stent (LAMS) is considered the first-line therapy for symptomatic pancreatic fluid collections (PFCs). Routine coaxial placement of a double-pigtail stent (DPS) through LAMS is debated. We report the case of a patient with delayed massive gastrointestinal bleed eight weeks after LAMS placement due to splenic artery pseudoaneurysm leading to a complicated hospitalization. Theoretically, coaxial placement of DPS through LAMS can prevent the relatively sharp LAMS from eroding into the mucosa of the collapsed cavity of PFCs, decreasing the risk of bleeding. Our case adds to the growing need to further explore the utility of this combined intervention.
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Affiliation(s)
- Shehroz Aslam
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Zaid Ansari
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Mustafa Alani
- Gastroenterology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Indu Srinivasan
- Gastroenterology, Valleywise Health Medical Center, Phoenix, USA.,Gastroenterology, Creighton University School of Medicine, Phoenix, USA
| | - Keng-Yu Chuang
- Gastroenterology, Valleywise Health Medical Center, Phoenix, USA.,Gastroenterology, Creighton University School of Medicine, Phoenix, USA
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Naik P, Sahoo MR, Nayak J. Comparison of surgical outcome between conventional laparoscopic cystogastrostomy method and plication of the edge of anterior gastrotomy in patients with pancreatic pseudocyst: A retrospective study at two tertiary care centres. J Minim Access Surg 2021; 18:181-185. [PMID: 33605931 PMCID: PMC8973493 DOI: 10.4103/jmas.jmas_201_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In retro-gastric Pancreatic pseudocyst (PP) Laparoscopic cystogastrostomy (LCG) is an established procedure of drainage. Aims and Objectives To compare surgical outcome between laparoscopic cysto-gastrostomy conventional method and plication of the edge of anterior gastrotomy in patients of pancreatic pseudocyst. Materials and Methods Twenty six patients were underwent LCG from 2010-2020 by a single surgeon. Both the conventional LCG group Group-1(Gr-1) and the plication group Group-2 (Gr-2) where plication of edge of anterior gastrostomy was performed, contained 13 patients each. Results The numbers of male/female in Gr-1 was 9/4 and that in Gr-2 was 10/3 (P = 1). Mean ages of patients were 45.3 ± 10.4 years (range 23-60) in Gr-1 and 48.0 ± 12.3 years (range 27-65) in Gr-2. Etiological factors were alcohol (46.1% in Gr-1, 53.8% in Gr-2), gallstone disease (38.4% in Gr-1,15.3% in Gr-2), trauma (15.3% in each groups), idiopathic cause (15.3% in Gr-2). The cyst size was 9.0 ± 1.5 cm in Gr-1and 8.9 ± 2.1cm in Gr-2. The mean operative time in Gr-1 (107.6 ± 12.5 minutes) was longer than Gr-2 (97 ± 1 3.6 minutes) (P = 0.06). The size of cystogastric anastomosis in Gr-1 was 4.6 ± 0.7 cm and that in Gr-2 was 4 ± 0.8 cm (P = 0.04). The intra-operative blood loss in Gr-1 and Gr-2 were 101.9 ± 21.7ml and 78.4 ± 30.7 ml respectively. There was a significant change in intraoperative blood loss and stoma size in Gr-2. The postoperative complications were managed conservatively. No recurrence over a period of 18 months of follow-up. Conclusion Plication of edges of anterior gastrostomy result in reduction in operative time, smaller anastomosis without complication and less intra-operative blood loss.
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Affiliation(s)
- Prabhas Naik
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manash Ranjan Sahoo
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Gupta R, Singh A, Ammar H. A Case of Incidental Gastrointestinal Stromal Tumor in a Patient With Walled-Off Pancreatic Necrosis. Cureus 2020; 12:e10681. [PMID: 33133847 PMCID: PMC7593124 DOI: 10.7759/cureus.10681] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis is a common clinical disorder of the pancreas that can present with walled-abdominal pain and vomiting. We report a case of a 45-year-old man with alcohol-related acute pancreatitis who developed a large walled-off pancreatic necrosis. Incidentally, the patient had a small gastrointestinal stromal tumor in the adjoining wall of the stomach that was missed on preoperative radiological imaging. A small submucosal lesion was detected during cystogastrostomy and was excised. The diagnosis of a gastrointestinal stromal tumor was confirmed on histopathology.
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Affiliation(s)
- Rahul Gupta
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Arvind Singh
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
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8
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Kotb M, Oshiba A, Ashour K. Pseudopancreatic Cyst Extending into the Mediastinum in a 7-Year-Old Child. European J Pediatr Surg Rep 2019; 7:e24-e27. [PMID: 31214482 PMCID: PMC6579729 DOI: 10.1055/s-0039-1688802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/31/2019] [Indexed: 01/23/2023] Open
Abstract
Mediastinal pseudopancreatic cyst (MPP) is the extension of a pancreatic pseudocyst through esophageal or aortic hiatus into the posterior mediastinum. It can produce a range of manifestations caused by compression by the cyst, for instance, odynophagia, dysphagia, pericardial, or pleural effusion. Here we report a case of MPP in a 7-year-old child who was presented with repeated chest infections and left pleural effusion. It was successfully drained by cystogastrostomy.
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Affiliation(s)
- Mostafa Kotb
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Oshiba
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Khaled Ashour
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
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Renelus BD, Jamorabo DS, Gurm HK, Dave N, Briggs WM, Arya M. Comparative outcomes of endoscopic ultrasound-guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis. Ther Adv Gastrointest Endosc 2019; 12:2631774519843400. [PMID: 31192314 PMCID: PMC6537502 DOI: 10.1177/2631774519843400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/16/2018] [Accepted: 03/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Endoscopic ultrasound–guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature. Methods: We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound–guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents. Results: Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83–92 with I2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant). Conclusion: Endoscopic ultrasound–guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.
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Affiliation(s)
- Benjamin D Renelus
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Daniel S Jamorabo
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Hashroop K Gurm
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Niel Dave
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - William M Briggs
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA
| | - Mukul Arya
- Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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10
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Saluja SS, Srivastava S, Govind SH, Dahale A, Sharma BC, Mishra PK. Endoscopic cystogastrostomy versus surgical cystogastrostomy in the management of acute pancreatic pseudocysts. J Minim Access Surg 2019; 16:126-131. [PMID: 30777987 PMCID: PMC7176009 DOI: 10.4103/jmas.jmas_109_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Studies comparing surgical versus endoscopic drainage of pseudocyst customarily include patients with both acute and chronic pseudocysts and the endoscopic modalities used for drainage are protean. We compared the outcomes following endoscopic cystogastrostomy (ECG) and surgical cystogastrostomy (SCG) in patients with acute pseudocyst. Methods: Seventy-three patients with acute pseudocyst requiring drainage from 2011 to 2014 were analysed (18 patients excluded: transpapillary drainage n = 15; cystojejunostomy n = 3). The remaining 55 patients were divided into two groups, ECG n = 35 and SCG n = 20, and their outcomes (technical success, successful drainage, complication rate and hospital stay) were compared. Results: The technical success (31/35 [89%] vs. 20/20 [100%] P = 0.28), complication rate (10/35 [28.6%] vs. 2/20 [10%]; P = 0.17) and median hospital stay (6.5 days [range 2–12] vs. 5 days [range 3–12]; P = 0.22) were comparable in both the groups, except successful drainage which was higher in surgical group (27/35 [78%] vs. 20/20 [100%] P = 0.04). The conversion rate to surgical procedure was 17%. The location of cyst towards tail of pancreas and presence of necrosis were the main causes of technical failure and failure of successful endoscopic drainage, respectively. Conclusion: Surgical drainage albeit remains the gold standard for management of pseudocyst drainage; endoscopic drainage should be considered a first-line treatment in patients with acute pseudocyst considering the reasonably good success rate.
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Affiliation(s)
- Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - S Hari Govind
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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11
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Ray S, Khamrui S, Kataria M, Biswas J, Saha S. Valproic Acid-Induced Severe Acute Pancreatitis with Pseudocyst Formation: Report of a Case. Cureus 2015; 7:e297. [PMID: 26366333 PMCID: PMC4564375 DOI: 10.7759/cureus.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2015] [Indexed: 11/17/2022] Open
Abstract
Valproic acid is the most widely used anti-epileptic drug in children, and it is probably the most frequent cause of drug-induced acute pancreatitis. Outcomes for patients with valproic acid-associated pancreatitis vary from full recovery after discontinuation of the drug to severe acute pancreatitis and death. Here, we present a case of valproic acid-induced severe acute pancreatitis with pseudocyst formation in a 10-year-old girl with cerebral palsy and generalized tonic-clonic seizure. There was no resolution of the pseudocyst after discontinuation of valproic acid. The patient became symptomatic with a progressive increase in the size of the pseudocyst. She was successfully treated with cystogastrostomy and was well at 12-month follow-up.
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Affiliation(s)
- Sukanta Ray
- Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research
| | - Sujan Khamrui
- Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research
| | - Mohnish Kataria
- Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research
| | - Jayanta Biswas
- Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research
| | - Suman Saha
- Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research
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12
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Slater BJ, Pimpalwar A. Laparoscopic gastroscopic transgastric cystogastrostomy and cholecystectomy for pseudopancreatic cyst after gallstone pancreatitis in children. European J Pediatr Surg Rep 2015; 2:10-2. [PMID: 25755959 PMCID: PMC4335947 DOI: 10.1055/s-0033-1357503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/26/2013] [Indexed: 01/03/2023] Open
Abstract
A 15-year-old girl presented with gallstone pancreatitis. Subsequently, a pseudopancreatic cyst developed that was diagnosed on computed tomographic scan. She underwent a laparoscopic and gastroscopic transgastric cystogastrostomy. In the following report, we describe our novel approach and technique for the above condition.
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Affiliation(s)
- Bethany J Slater
- Division of Pediatric Surgery, Michael E Debakey Department of General Surgery, Baylor College of Medicine and Texas Children Hospital, Houston, Texas, United States
| | - Ashwin Pimpalwar
- Division of Pediatric Surgery, Michael E Debakey Department of General Surgery, Baylor College of Medicine and Texas Children Hospital, Houston, Texas, United States
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13
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Mavrodin CI, Pariza G, Iordache V, Pop CS. Massive upper gastrointestinal bleeding - complication of pancreatic pseudocyst. J Med Life 2014; 7:202-4. [PMID: 25408725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/07/2014] [Indexed: 10/26/2022] Open
Abstract
Massive bleeding is an unusual complication of pancreatitis. Most patients have chronic pancreatic disorders associated with pancreatic pseudocyst. We present the case of a patient, aged 49 years, known with alcohol-induced chronic pancreatitis, corporeal-caudal pancreatic pseudocyst expanded in the omental bursa, admitted to the emergency room because of hematemesis and melena, the endoscopy revealing, as a source, the erosion through the posterior gastric wall by the pseudocyst. The gastrostomy and haemostasis in situ of the source and the pseudocyst-gastric anastomosis was the solution adopted, with favourable long-term evolution.
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Shimizu S, Morisaki T, Noshiro H, Mizumoto K, Yamaguchi K, Chijiiwa K, Tanaka M. Laparoscopic cystogastrostomy for pancreatic pseudocyst: a case report. JSLS 2000; 4:309-12. [PMID: 11051191 PMCID: PMC3113193] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 49-year-old man with a history of acute pancreatitis was hospitalized with a diagnosis of pancreatic pseudocyst. Ultrasonography, computed tomography, and magnetic resonance imaging all demonstrated a homogeneous cyst, 9 x 4 cm in size, at the tail of the pancreas without mural nodules or septa. Because an intestinal structure was identified between the cyst and stomach preoperatively by computed tomography and endoscopic ultrasonography, laparoscopic cystogastrostomy was carried out instead of percutaneous or endoscopic cyst drainage. The cyst was exposed by dissecting the lesser omentum and found to have no adhesion to the surrounding tissues. Anastomosis was performed using an endoscopic linear stapler via small cystotomy and gastrotomy openings on the lesser curvature, which were then sutured laparoscopically. The postoperative course was uneventful. Laparoscopic surgery is recommended as a safe, reliable, and minimally invasive treatment for managing pancreatic pseudocyst.
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Affiliation(s)
- S Shimizu
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka, Japan.
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