|
1
|
Chon HK, Kozarek RA. History of the Interventional Pancreaticobiliary Endoscopy. Gastrointest Endosc Clin N Am 2024; 34:383-403. [PMID: 38796288 DOI: 10.1016/j.giec.2023.12.001] [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] [Indexed: 05/28/2024]
Abstract
With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an enormous impact in the management of pancreatic and biliary diseases. Continuous efforts to improve various devices and techniques have revolutionized these treatment modalities as viable alternatives to surgery. In recent years, trends toward combining endoscopic techniques with other modalities, such as laparoscopic and radiological interventions, for complex PB diseases have emerged using a multidisciplinary approach. Ongoing research and clinical experience will lead to refinements in interventional PB endoscopic techniques and subsequently improve outcomes and reduce complication rates.
Collapse
Affiliation(s)
- Hyung Ku Chon
- Division of Biliopancreas, Department of Internal Medicine, Wonkwang University Medical School, and Hospital, Iksan, Republic of Korea; Institution of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Richard A Kozarek
- Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, 1100 Ninth Avenue, Seattle, WA 98101, USA; Center for Interventional Immunology, Benaroya Research Institute, Virginia Mason Franciscan Health, 1201 Ninth Avenue, Seattle, WA 98101, USA.
| |
Collapse
|
|
2
|
Cui Y, Kozarek RA. Evolution of Pancreatic Endotherapy. Gastrointest Endosc Clin N Am 2023; 33:679-700. [PMID: 37709404 DOI: 10.1016/j.giec.2023.03.012] [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] [Indexed: 09/16/2023]
Abstract
In the last half century, endotherapy for pancreatic diseases has changed considerably. Although endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were introduced initially as diagnostic tools, they quickly evolved into therapeutic tools for preventing and managing complications of pancreatitis. More recently, therapeutic endoscopy has shown potential in palliation and cure of pancreatic neoplasms. This article discusses the changing landscape of pancreatic endotherapy as therapeutic ERCP and EUS were introduced and because they have evolved to treat different diseases.
Collapse
Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, Virginia Mason Medical Center
| | | |
Collapse
|
|
3
|
Ryozawa S. Pancreato-hepatobiliary endoscopy: Intervention for pancreatic diseases. Dig Endosc 2022; 34 Suppl 2:120-123. [PMID: 34431144 DOI: 10.1111/den.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
|
4
|
Monino L, Deprez PH. Complications of Pancreatic Stents. GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:1703-1718. [DOI: 10.1007/978-3-030-56993-8_99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
5
|
Jiang L, Ning D, Cheng Q, Chen XP. Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis. Int J Surg 2018; 54:242-247. [DOI: 10.1016/j.ijsu.2018.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/22/2018] [Accepted: 04/13/2018] [Indexed: 01/10/2023]
|
|
6
|
Risk factors for migration, fracture, and dislocation of pancreatic stents. Gastroenterol Res Pract 2015; 2015:365457. [PMID: 25945085 PMCID: PMC4402177 DOI: 10.1155/2015/365457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/25/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. To analyze the risk factors for pancreatic stent migration, dislocation, and fracture in chronic pancreatitis patients with pancreatic strictures. Materials and Methods. Endoscopic stent placements (total 386 times) were performed in 99 chronic pancreatitis patients with pancreatic duct stenosis at our institution between April 2006 and June 2014. We retrospectively examined the frequency of stent migration, dislocation, and fracture and analyzed the patient factors and stent factors. We also investigated the retrieval methods for migrated and fractured stents and their success rates. Results. The frequencies of stent migration, dislocation, and fracture were 1.5% (5/396), 0.8% (3/396), and 1.2% (4/396), respectively. No significant differences in the rates of migration, dislocation, or fracture were noted on the patient factors (etiology, cases undergoing endoscopic pancreatic sphincterotomy, location of pancreatic duct stenosis, existence of pancreatic stone, and approach from the main or minor papilla) and stent factors (duration of stent placement, numbers of stent placements, stent shape, diameter, and length). Stent retrieval was successful in all cases of migration. In cases of fractured stents, retrieval was successful in 2 of 4 cases. Conclusion. Stent migration, fracture, and dislocation are relatively rare, but possible complications. A good understanding of retrieval techniques is necessary.
Collapse
|
|
7
|
Kim YH, Jang SI, Rhee K, Lee DK. Endoscopic treatment of pancreatic calculi. Clin Endosc 2014; 47:227-35. [PMID: 24944986 PMCID: PMC4058540 DOI: 10.5946/ce.2014.47.3.227] [Citation(s) in RCA: 18] [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: 04/11/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 12/16/2022] Open
Abstract
Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal.
Collapse
Affiliation(s)
- Yong Hoon Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kwangwon Rhee
- Department of Internal Medicine, Godoil Hospital, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
|
8
|
Inui K, Yoshino J, Miyoshi H, Yamamoto S, Kobayashi T. New developments in diagnosis and non-surgical treatment of chronic pancreatitis. J Gastroenterol Hepatol 2013; 28 Suppl 4:108-12. [PMID: 24251715 DOI: 10.1111/jgh.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 01/18/2023]
Abstract
Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented.
Collapse
Affiliation(s)
- Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University School of Medicine, Nakagawa-ku, Nagoya, Japan
| | | | | | | | | |
Collapse
|
|
9
|
Farnbacher MJ, Berner L, Raithel M, Hahn EG, Schneider HT. Cleaning of occluded pancreatic duct endoprostheses: a new indication for extracorporeal shock wave lithotripsy? Gastrointest Endosc 2011; 74:527-34. [PMID: 21704991 DOI: 10.1016/j.gie.2011.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/20/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic duct stenting is widely performed for bridging main pancreatic duct obstruction in patients with chronic pancreatitis. The major limitation is early stent occlusion, making regular stent exchange necessary. OBJECTIVE To date, no measures are available to prevent stent occlusion. The aim of this study was to evaluate the cleansing effect of shock wave application (SWA) on occluded pancreatic duct stents in vitro. DESIGN In vitro study. PATIENTS We analyzed occlusion rates of 25 plastic endoprostheses removed from 21 patients with chronic pancreatitis. INTERVENTION We administered 350 shock wave pulses every 10 mm along the prosthesis, which was stored in a latex balloon filled with gas-free physiologic saline solution, by using a pressure of 42 megapascals. MAIN OUTCOME MEASUREMENTS After SWA, the occlusion rate was measured again, and the cleansing rate was calculated in comparison with the native prosthesis. RESULTS The mean (± SD) occlusion rate was significantly reduced (64.7 ± 28.7 [15%-100%]) before SWA vs 9.8 ± 25.3 [0-100%]) after SWA; P = .038). In 16 of 25 prostheses (64%), cleaning was complete. Four of the remaining 9 prostheses (16%) showed satisfactory cleaning of 95%, on average. Residual clogging material was found mainly at the duodenal tip and the middle of the stent. No significant association was found between patient-related or stent-related parameters and the cleansing effect of SWA. LIMITATIONS In vitro study design. CONCLUSION SWA is effective in cleaning occluded pancreatic endoprostheses in vitro. Prolongation of stent placement seems possible if regular SWA is performed. Extracorporeal shock wave lithotripsy therefore might become a new indication for patients under treatment with pancreatic endoprostheses.
Collapse
|
|
10
|
Udd M, Kylänpää L, Halttunen J. Management of difficult bile duct cannulation in ERCP. World J Gastrointest Endosc 2010; 2:97-103. [PMID: 21160709 PMCID: PMC2999064 DOI: 10.4253/wjge.v2.i3.97] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 01/29/2010] [Accepted: 02/05/2010] [Indexed: 02/05/2023] Open
Abstract
In Encoscopic Retrograde Cholangiopancreatography (ERCP), the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis. Difficult cannulation is defined as a situation where the endoscopist, using his/her regularly used cannulation technique, fails within a certain time limit or after a certain number of unsuccessful attempts. Different methods have been developed to manage difficult cannulation. The most common solution is to perform a precut papillotomy either with a needle knife or with a sphincterotome with or without a guide wire. This review describes different methods to overcome cases of difficult cannulation. We will discuss the success rate and complication rates associated with different methods of reaching the biliary tract.
Collapse
Affiliation(s)
- Marianne Udd
- Marianne Udd, Leena Kylänpää, Jorma Halttunen, Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, POB 340, HUS 00029, Helsinki, Finland
| | | | | |
Collapse
|
|
11
|
Joo YW, Yoon JH, Cho SC, Lee KN, Ha NR, Lee HL, Lee OY, Yoon BC, Choi HS, Hahm JS, Lee DH, Lee MH. Endoscopic pancreatic sphincterotomy: indications and complications. Korean J Intern Med 2009; 24:190-5. [PMID: 19721854 PMCID: PMC2732777 DOI: 10.3904/kjim.2009.24.3.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 09/25/2008] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/AIMS Although a few recent studies have reported the effectiveness of endoscopic pancreatic sphincterotomy (EPST), none has compared physicians' skills and complications resulting from the procedure. Thus, we examined the indications, complications, and safety of EPST performed by a single physician at a single center. METHODS Among 2,313 patients who underwent endoscopic retrograde cholangiopancreatography between January 1996 and March 2008, 46 patients who underwent EPST were included in this retrospective study. We examined the indications, complications, safety, and effectiveness of EPST, as well as the need for a pancreatic drainage procedure and the concomitant application of EPST and endoscopic sphincterotomy (EST). RESULTS Diagnostic indications for EPST were chronic pancreatitis (26 cases), pancreatic divisum (4 cases), and pancreatic cancer (8 cases). Therapeutic indications for EPST were removal of a pancreaticolith (10 cases), stent insertion for pancreatic duct stenosis (9 cases), nasopancreatic drainage (7 cases), and treatment of sphincter of Oddi dysfunction (1 case). The success rate of EPST was 95.7% (44/46). Acute complications of EPST included five cases (10.9%) of pancreatitis and one of cholangitis (2.2%). EPST with EST did not reduce biliary complications. Endoscopic pancreatic drainage procedures following EPST did not reduce pancreatic complications. CONCLUSIONS EPST showed a low incidence of complications and a high rate of treatment success; thus, EPST is a relatively safe procedure that can be used to treat pancreatic diseases. Pancreatic drainage procedures and additional EST following EPST did not reduce the incidence of procedure-related complications.
Collapse
Affiliation(s)
- Yong Won Joo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jai Hoon Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Chul Cho
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kang Nyeong Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Na Rae Ha
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hang Lak Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung Chul Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joon Soo Hahm
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Hoo Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
|
12
|
Halttunen J, Keränen I, Udd M, Kylänpää L. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009; 23:745-9. [PMID: 18649101 DOI: 10.1007/s00464-008-0056-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 05/27/2008] [Accepted: 06/12/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND In endoscopic retrograde cholangiopancreaticography (ERCP) difficult cannulation is an independent risk factor for complications. METHODS Altogether 6,209 ERCPs were performed in Helsinki University Central Hospital in the period 1996-2006. In 558 cases (9%) without a previous sphincterotomy, direct access into the biliary duct could not be achieved. In this group access was attempted by first performing a pancreatic sphincterotomy in 351 difficult cannulation cases (63%). A needle knife precut without a pancreatic sphincterotomy was performed in 178 cases (32%). All the necessary clinical and laboratory information was available for 262 of the 351 patients who had undergone a pancreatic sphincterotomy and for 157 of the 178 patients who had been subjected to needle knife precutting, and these data were further evaluated in this study. RESULTS The pancreatic sphincterotomy technique was successful in 255 cases (97.3%). Post-ERCP pancreatitis developed in 8.8% of the pancreatic sphincterotomy group. In 147 patients, biliary cannulation was successful following a pancreatic sphincterotomy, and the post-ERCP pancreatitis rate for those patients was 9.3%. In 108 patients, a needle knife papillotomy, in addition to a pancreatic sphincterotomy, was necessary and resulted in a post-ERCP pancreatitis rate of 8.2%. In the needle knife precut group only, post-ERCP pancreatitis developed in 5.1% of cases. Biliary cannulation succeeded less frequently following needle knife precutting than following the pancreatic sphincterotomy technique (71.3% versus 97.3%, p<0.001). There was no significant difference in the post-ERCP pancreatitis rate between the precut and pancreatic sphincterotomy techniques (p=0.16). CONCLUSIONS In difficult cannulation, a pancreatic sphincterotomy to achieve deep biliary duct cannulation can be performed with a high success rate (failure rate less than 3%). The corresponding success rate using the needle knife precut technique is 71%. In both methods the risk for post-ERCP pancreatitis is comparable to that of a standard biliary sphincterotomy.
Collapse
Affiliation(s)
- Jorma Halttunen
- Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | |
Collapse
|
|
13
|
Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy. ACTA ACUST UNITED AC 2008; 15:377-83. [DOI: 10.1007/s00534-008-1332-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 02/20/2008] [Indexed: 01/19/2023]
|
|
14
|
Abstract
Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, new improvements were necessary: failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated.
Collapse
|
|
15
|
OKUSHIMA K, NAKAZAWA S, YAMAO K, YOSHINO J, INUI K, YAMACHIKA H, KANEMAKI N, IWASE T, KISHI K, FUJIMOTO M, WATANABE M, HIRANO K, HARADA K, MIYOSHI H, NIMURA Y. A Case of Pancreatolithiasis Treated by a Combination of Endoscopic Extraction and Extracorporeal Shock Wave Lithotripsy. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1992.tb00112.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | - Saburo NAKAZAWA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kenji YAMAO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Junji YOSHINO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kazuo INUI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Hitoshi YAMACHIKA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Naoto KANEMAKI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Teruhiko IWASE
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Katsuhiko KISHI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Masao FUJIMOTO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Masumi WATANABE
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Ken HIRANO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kou HARADA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Hironao MIYOSHI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Yuji NIMURA
- **First Department of Surgery, Nagoya University, School of Medicine, Nagoya, Japan
| |
Collapse
|
|
16
|
Sasahira N, Tada M, Isayama H, Hirano K, Nakai Y, Yamamoto N, Tsujino T, Toda N, Komatsu Y, Yoshida H, Kawabe T, Omata M. Outcomes after clearance of pancreatic stones with or without pancreatic stenting. J Gastroenterol 2007; 42:63-9. [PMID: 17322995 DOI: 10.1007/s00535-006-1972-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 10/21/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extracorporeal shockwave lithotripsy (ESWL) and endoscopic lithotripsy are useful for the fragmentation and extraction of pancreatic stones. However, pancreatic stones often recur, for which an adequate strategy is needed. Treatment for stricture of the main pancreatic duct (MPD) with a pancreatic stent after clearance of pancreatic stones may reduce the recurrence of pancreatic symptoms and stones. METHODS Forty patients with chronic pancreatitis with MPD stones were treated with ESWL in combination with endoscopic stone extraction. After clearance of the stones, a pancreatic stent was inserted when a stricture of MPD was observed on pancreatography. The stent was exchanged every 3 months and removed after a total of 1 year. We examined episodes of recurrent pain and pancreatitis in patients with and without stenting, as well as the MPD diameter, during follow-up. RESULTS MPD stricture was seen in 27 patients, and a stent was successfully inserted in 24 of them. Pancreatic symptoms recurred in five patients (21%) in the stenting group and in three patients (23%) in the control group during a mean follow-up period of 1.5 and 1.2 years, respectively. The diameter of the MPD, before, just after, and 1 year after treatment, was 7.6, 5.4, and 5.8 mm, respectively. It was significantly decreased after 1 year of follow-up, as well as just after stent removal, compared with before treatment (P < 0.05). CONCLUSIONS Additional stenting for MPD after extraction of pancreatic stones may reduce the risk of recurrence of pancreatic symptoms.
Collapse
Affiliation(s)
- Naoki Sasahira
- Department of Gastroenterology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Varadarajulu S, Wilcox CM. Randomized trial comparing needle-knife and pull-sphincterotome techniques for pancreatic sphincterotomy in high-risk patients. Gastrointest Endosc 2006; 64:716-722. [PMID: 17055863 DOI: 10.1016/j.gie.2006.02.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 02/25/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND Accepted techniques for pancreatic sphincterotomy include use of a needle knife or a pull sphincterotome to ablate the sphincter. There are no prospective studies comparing outcomes between both techniques. AIM Compare post-ERCP pancreatitis rates among high-risk patients undergoing pancreatic sphincterotomy with the pull-sphincterotome versus needle-knife technique. STUDY DESIGN Prospective, randomized trial. METHODS Patients diagnosed with pancreatic sphincter hypertension at sphincter of Oddi manometry were randomized to undergo pancreatic sphincterotomy with a pull sphincterotome (followed by pancreatic stenting) or a needle knife over a pancreatic stent. MAIN OUTCOME MEASUREMENTS To compare post-ERCP pancreatitis rates between the pull-sphincterotome and needle-knife groups. RESULTS Forty-eight patients were randomized. Patient demographics and the incidence of patient and procedure risk factors for pancreatitis were similar in both treatment groups. The trial was stopped early after an interim analysis showed that post-ERCP pancreatitis was significantly higher among patients undergoing sphincterotomy with a pull sphincterotome than a needle knife (7/24 = 29% [95% CI 13-51] vs 0/24 = 0% [95% CI 0-12]; P = .01). No other complications were encountered. At a mean follow-up of 12 months (range 6-18 months), 60% of patients had complete symptom relief, 15% partial symptom relief, and 25% recurrent symptoms. Reintervention rates and clinical outcomes were not significantly different between the 2 groups. LIMITATIONS Short duration of follow-up. CONCLUSIONS Pancreatic sphincterotomy is safer in high-risk patients when performed with a needle knife over a pancreatic stent.
Collapse
Affiliation(s)
- Shyam Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA
| | | |
Collapse
|
|
18
|
Siegel JH, Cohen SA. Pull or push pancreatic sphincterotomy for sphincter of Oddi dysfunction? A conundrum for experts only. Gastrointest Endosc 2006; 64:723-5. [PMID: 17055864 DOI: 10.1016/j.gie.2006.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 04/27/2006] [Indexed: 02/08/2023]
|
|
19
|
Tadenuma H, Ishihara T, Yamaguchi T, Tsuchiya S, Kobayashi A, Nakamura K, Sakurada R, Saisho H. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol 2005; 3:1128-35. [PMID: 16271345 DOI: 10.1016/s1542-3565(05)00530-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the short- and long-term results of extracorporeal shockwave lithotripsy (ESWL) and endoscopic therapy for pancreatic stones. METHODS A total of 117 patients with pancreatic stones underwent ESWL and endoscopic treatment in our institute. Seventy patients who were followed-up for over 3 years after treatment were evaluated retrospectively. RESULTS Immediate pain relief was achieved in 97% and complete removal of stones was achieved in 56%. During the long-term follow-up evaluation, 49 of 70 patients continued to be asymptomatic. Pain recurred more frequently in patients with incomplete removal than in those with complete removal (P < .05). Twenty-one patients who became symptomatic during the follow-up period underwent additional therapy, and pain relief was attained without surgery in all of them. Both endocrine and exocrine function deteriorated after the long-term follow-up period (P < .05). CONCLUSIONS ESWL and endoscopic treatment of pancreatic stones proved to be effective for long-term pain relief, especially in patients in whom stones were removed completely at initial therapy.
Collapse
Affiliation(s)
- Hiroshi Tadenuma
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-01 Inohana, Chuoku, Chiba 260-0805, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
|
20
|
Affiliation(s)
- J R Izbicki
- Department of Surgery, University Hospital Eppendorf, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany.
| | | |
Collapse
|
|
21
|
Inui K, Yoshino J, Okushima K, Miyoshi H, Nakamura Y. MERITS and DEMERITS OF METALLIC STENT FOR TREATMENT OF PANCREATIC DUCT STRICTURES IN PATIENTS WITH CHRONIC PANCREATITIS. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00384.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
|
22
|
Affiliation(s)
- James Rhee
- University of Michigan Medical Center, Ann Arbor, USA
| | | | | |
Collapse
|
|
23
|
Abstract
Endoscopic treatment of chronic pancreatitis is becoming a reality: more and more endoscopy centres are developing the technique, and it is no longer a matter of extreme specialization. Among treatments which have been shown to be feasible, it is possible to distinguish between those approaches that are now considered as efficient with good results and very low risk (e.g. MPD drainage), or are efficient but with risks that seem to be lower than those of surgery (e.g. drainage of cysts), and drainage of the main bile duct, which is easy to perform, but, so far, has not been demonstrated enough as useful.
Collapse
Affiliation(s)
- René Laugier
- Department of Gastroenterology, La Timone Hospital, 264 rue St Pierre, Marseille, France.
| | | |
Collapse
|
|
24
|
Aoki S, Okayama Y, Hayashi K, Imai H, Okamoto T, Kobayashi S, Shiraki S, Gotoh K, Sano H, Ohara H, Nomura T, Joh T, Yokoyama Y, Itoh M. A Case of Purulent Pancreatic Ductitis Successfully Treated by Endoscopic Stenting. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2000.00072.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Shigeru Aoki
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Yasutaka Okayama
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Katsuki Hayashi
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Hideto Imai
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Tetsu Okamoto
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Shinya Kobayashi
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Shigehiro Shiraki
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Kazuo Gotoh
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Hitoshi Sano
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Hirotaka Ohara
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Tomoyuki Nomura
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Takashi Joh
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Yoshifumi Yokoyama
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| | - Makoto Itoh
- *Department of Gastroenteology, Gifu Prefectural Taijim Hospital, Tajimi, Gifu and † The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan
| |
Collapse
|
|
25
|
Abstract
BACKGROUND Endoscopic pancreatic sphincterotomy has been touted as effective therapy for chronic pancreatitis and unexplained abdominal pain resulting from pancreatic sphincter dysfunction. Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months. METHODS We performed a retrospective review of records on all patients who had pancreatic sphincterotomy during a 4-year period between August 1992 and November 1996. Chronic pancreatitis was diagnosed by pancreatography. Patients were evaluated for symptomatic response to pancreatic sphincterotomy and clinical improvement was defined as greater than 50% reduction in the magnitude of pain. RESULTS Fifty-five patients had pancreatic sphincterotomy including patients with (n = 40) and without (n = 15) chronic pancreatitis. After a median follow-up of 16 months, 60% of all patients reported improvement of pain scores (3.6 +/- 3.4 vs. 8.8 +/- 1.8; p < 0.01) with the best response in patients without evidence of chronic pancreatitis. Complications of pancreatic sphincterotomy included pancreatitis in 5 patients (9%), bleeding in 2 (3.6%) and early stent occlusion in 5 patients (9%). There were no deaths. CONCLUSIONS In a subgroup of patients with pancreatic sphincter dysfunction, endoscopic pancreatic sphincterotomy results in significant sustained clinical improvement.
Collapse
Affiliation(s)
- P I Okolo
- Division of Gastroenterology, The Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | | | | |
Collapse
|
|
26
|
Ell C, Rabenstein T, Schneider HT, Ruppert T, Nicklas M, Bulling D. Safety and efficacy of pancreatic sphincterotomy in chronic pancreatitis. Gastrointest Endosc 1998; 48:244-9. [PMID: 9744598 DOI: 10.1016/s0016-5107(98)70185-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic pancreatic sphincterotomy (EPS) is being performed with increasing frequency as a prerequisite to interventional measures in the pancreatic duct. The aim of this study was to evaluate EPS with regard to technique, success, complications, and mortality in patients with chronic pancreatitis. METHODS Between January 1989 and September 1996, the results of all consecutive EPSs in patients with chronic pancreatitis were documented in a standardized form. Patients were followed by clinical investigation and blood sample analysis at 4, 24, and 48 hours after EPS. Complications were classified according to commonly accepted criteria. RESULTS EPS was performed in 118 patients with chronic pancreatitis (men 75%, women 25%, 48+/-10 years). Ninety-four patients (80%) underwent guidewire-assisted EPS, and 24 patients (20%) underwent needle-knife EPS. Seventy-seven EPS procedures (65%) were primarily successful (guidewire EPS: 60 of 94, 64%; needle-knife EPS: 17 of 24, 71%). Additional endoscopic cutting techniques (needle-knife papillotomy, biliary endoscopic sphincterotomy) were required in 41 patients (35%). In total, EPS was successful in 116 patients (98%). The complication rate was 4.2% (4 cases of moderate pancreatitis, 1 severe bleeding, no deaths). All complications were managed nonoperatively. CONCLUSIONS In patients with chronic pancreatitis, EPS with a standard sphincterotome or with a needle-knife offers an effective and reliable approach to the pancreatic duct system. Additional cutting techniques may be necessary in approximately one third of cases before an EPS can be successfully performed. The complication rate of EPS in patients with chronic pancreatitis appears to be lower than the complication rate of biliary sphincterotomy for other indications.
Collapse
Affiliation(s)
- C Ell
- Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | | | |
Collapse
|
|
27
|
Abstract
BACKGROUND The objective of the present investigation was to assess the risks and benefits of pre-cutting with the needle knife at the papilla of Vater and to compare the findings with the results of classic endoscopic sphincterotomy. METHODS From January 1973 to December 1993, 2752 endoscopic cutting procedures-biliary or pancreatic sphincterotomy (EST) or needle-knife papillotomy (NKP)-were performed. Since 1981 the pre-cut technique with the needle knife has been used alone or in combination with standard sphincterotomy. Indications, success, and complications of NKP and EST were analyzed retrospectively. To demonstrate changes in indications and technique, the study period was divided into two time periods: period A, 1981 to 1987; and period B, 1988 to 1993. RESULTS Between 1981 and 1993, diagnostic or therapeutic access to the biliary or pancreatic duct system was attempted in 2105 patients by means of EST or related procedures (period A 1093 patients; period B 1012 patients). The overall success rate was 95.1% (2001 of 2105). In 694 of 2105 cases (33.0%) an EST was not possible or not attempted and an NKP was performed (period A 31.9%; period B 34.1%). This was successful in 590 of 694 cases (85.2%). The rate of NKP in relation to EST varied depending on the different indications for EST: 22.8% NKP in classic indications like choledocholithiasis and over 40% in newer indications such as chronic pancreatitis. In these novel indications NKP alone was often sufficient, and EST to complete the procedure was not necessary (151 patients). In period B, NKP (63 patients) and EST (23 patients) were also used to achieve endoscopic retrograde imaging of the biliary or pancreatic duct system when primary cannulation was not possible. Visualization was achieved in 81.4% (70 of 86) and pathologic findings were noted in 68.6% (59 of 86). The total complication rate of primary EST was 6.8% (96 of 1411) and 7.3% (51 of 694) for all procedures in which NKP was involved (NS). In period B the complication rate was 4.6% for NKP without subsequent EST and 7.6% for NKP in combination with EST. Compared with the complication rate of primary standard EST (6.1%) there was no statistically significant difference. CONCLUSIONS Needle-knife papillotomy increases the success of diagnostic and therapeutic procedures at the papilla of Vater. This pre-cut technique is safe and does not increase the overall complication risk of sphincterotomy.
Collapse
Affiliation(s)
- T Rabenstein
- Department of Medicine I, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | | | | | | | | |
Collapse
|
|
28
|
|
|
29
|
Matthews K, Correa RJ, Gibbons RP, Weissman RM, Kozarek RA. Extracorporeal shock wave lithotripsy for obstructing pancreatic duct calculi. J Urol 1997; 158:522-525. [PMID: 9224338 DOI: 10.1016/s0022-5347(01)64524-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE A review was done to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of impacted pancreatic duct calculi. MATERIALS AND METHODS A total of 19 patients, who were potential candidates for radical pancreatic surgery after unsuccessful endoscopic retrograde cholangiopancreatography, sphincterotomy and attempted stone extraction from the pancreatic ducts, underwent ESWL of the calculi. Followup ranged from 6 months to 6 years. RESULTS Of the 19 patients 14 avoided a major operation and 6 have remained pain-free for the long term. Two patients died of causes not related to ESWL or endoscopic retrograde cholangiopancreatography. Five patients eventually underwent a Whipple or Puestow procedure for relief of symptoms or persistent obstruction. Complications were minimal. CONCLUSIONS ESWL is a valuable adjunct in patients with impacted pancreatic duct calculi unretrievable by primary endoscopic retrograde cholangiopancreatography.
Collapse
Affiliation(s)
- K Matthews
- Section of Urology, Virginia Mason Medical Center, Seattle, Washington 98111, USA
| | | | | | | | | |
Collapse
|
|
30
|
Schreiber F, Gurakuqi GC, Pristautz H, Trauner M, Schnedl W. Sonographically-guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis. J Gastroenterol Hepatol 1996; 11:247-51. [PMID: 8742921 DOI: 10.1111/j.1440-1746.1996.tb00070.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Over a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone-free patients showed no further symptoms over the follow-up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow-up period.
Collapse
Affiliation(s)
- F Schreiber
- Department of Medicine, Karl Franzens University, Graz, Austria
| | | | | | | | | |
Collapse
|
|
31
|
Ponchon T, Bory RM, Hedelius F, Roubein LD, Paliard P, Napoleon B, Chavaillon A. Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. Gastrointest Endosc 1995; 42:452-6. [PMID: 8566637 DOI: 10.1016/s0016-5107(95)70049-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic endoscopic stenting aims to relieve abdominal pain due to chronic pancreatitis. Optimal treatment modalities and post-treatment effects have still to be determined. The object of this study was to investigate the results of a standardized protocol of endoscopic stenting. METHODS Twenty-three patients with abdominal pain due to chronic pancreatitis and stricture of the distal main pancreatic duct were treated according to the following protocol: after balloon dilation of the stenosis, a 10F stent was placed into the main pancreatic duct and then exchanged every 2 months, the total duration of drainage being 6 months. RESULTS Use of analgesics could be discontinued in 17 patients (74%) on termination of drainage, and in 12 patients (52%) 1 year later. These results were significantly associated with reduction of main pancreatic duct diameter and resolution of stricture, but were not influenced by abstinence from alcohol and pancreatic enzyme supplementation. CONCLUSIONS Pancreatic duct stenting results in short-term clinical improvement in patients with chronic pancreatitis and proximal main pancreatic duct stricture. Persistence of advantageous clinical results is to be expected in 50% of cases and when strictures have resolved.
Collapse
Affiliation(s)
- T Ponchon
- Department of Digestive Diseases, Hôpital E. Herriot, Lyon, France
| | | | | | | | | | | | | |
Collapse
|
|
32
|
Lehman GA, Sherman S, Hawes RH. Endoscopic management of recurrent and chronic pancreatitis. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1995; 208:81-9. [PMID: 7777810 DOI: 10.3109/00365529509107767] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Endoscopic therapy is now being utilized in the setting of recurrent acute and chronic pancreatitis. This review analyzes the current state of the art of these new applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. Patients with gallstone pancreatitis, pancreas divisum, obstructing main pancreatic duct stones, and bulging pseudocysts appear to be the best candidates for endoscopic therapy.
Collapse
Affiliation(s)
- G A Lehman
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis 46202, USA
| | | | | |
Collapse
|
|
33
|
Abstract
Performing sphincterotomy when either Billroth II gastrectomy or complicated periampullary diverticula are present may increase the risk of complications. In addition a sphincterotomy on the main pancreatic sphincter or the papilla of Santorini presents complicated problems. Stent-guided sphincterotomy has been utilized in 229 patients presenting to our institution from 1983 through 1992. They were performed in 67 patients who had undergone Billroth II gastrectomy, 23 with periampullary diverticula, 57 with pancreas divisum, and 82 with a history of recurrent pancreatitis. To prevent ductal injury or perforation, a stent is first inserted into the biliary or pancreatic duct to guide the sphincterotomy incision. The sphincterotomy is performed using electrocautery current delivered through a "needle knife" sphincterotome. Pancreatitis occurred in 19 patients (8.3%). It was mild in 17 and moderate in two patients. One patient experienced severe hemorrhage requiring surgery. No mortality or perforations occurred. The stent-guided needle knife sphincterotomy approach is an effective technique. It has a low complication rate even in these difficult anatomic conditions. It assures that the incision precisely follows the duct when performing pancreatic sphincterotomy.
Collapse
Affiliation(s)
- J H Siegel
- Section of Endoscopy, Beth Israel Medical Center North Division, New York, New York
| | | | | | | |
Collapse
|
|
34
|
Abstract
Stents have been effectively used for various pancreatic conditions. Pancreatic fistulas, however, have traditionally been considered a surgical disease, and if the fistula does not respond to conservative measures, an operation is usually performed. Stents were placed endoscopically in five consecutive patients who presented with pancreatic fistulas that did not respond to conservative management. Fistulas resolved in all patients after endoscopic stent placement, and after 14-30 months of follow-up, none has recurred. The cases comprise two patients with pancreaticocutaneous fistula and one each with pancreaticopleural, pancreaticoperitoneal, and pancreaticocholedochal fistula. The need for an operation can be obviated in many patients with internal and external pancreatic fistulas.
Collapse
Affiliation(s)
- Z A Saeed
- Gastrointestinal Endoscopy Unit, Veterans Affairs Medical Center, Houston, Texas
| | | | | |
Collapse
|
|
35
|
Linder S, Engström CF, von Rosen A, Wiechel KL. Endoscopic clearance of the pancreatic duct in chronic pancreatitis with severe pain. Surg Endosc 1993; 7:37-41. [PMID: 8424232 DOI: 10.1007/bf00591235] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a phase I study endoscopic removal of pancreatic duct stones and protein plugs was attempted in five patients suffering from chronic pancreatitis with severe chronic pain. The pancreatic duct contents could be extracted after successful sphincterotomy in three patients. Clearance of the pancreatic duct was followed by complete or partial relief of pain. The follow-up period was 17-48 months. Endoscopic extraction is, however, not without complications; it is technically difficult, and many attempts may be required. The combination of endoscopic therapy and extracorporeal shock-wave lithotripsy may be a better alternative.
Collapse
Affiliation(s)
- S Linder
- Department of Hepatobiliary and Pancreatic Diseases, Södersjukhuset, Stockholm, Sweden
| | | | | | | |
Collapse
|
|
36
|
Rawat B, Fache JS, Burhenne HJ. Extracorporeal shockwave lithotripsy of pancreatic duct stones. GASTROINTESTINAL RADIOLOGY 1992; 17:145-7. [PMID: 1551511 DOI: 10.1007/bf01888531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Encouraging results with extracorporeal shockwave lithotripsy (ESWL) for pancreatic duct stones have been reported from Europe. We present our experience with the first two North American patients, treated with excellent results in one and limited clinical improvement in the other patient at 1 year follow-up. Targeting of pancreatic duct stones was achieved with either fluoroscopy or ultrasound.
Collapse
Affiliation(s)
- B Rawat
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
|
37
|
Tanaka M, Yokohata K, Kimura H, Naritomi G, Ichimiya H, Minasi JS. Intraoperative endoscopic electrohydraulic lithotripsy of pancreatic stones. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1992; 12:227-31. [PMID: 1289415 DOI: 10.1007/bf02924361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two male patients with complications associated with chronic pancreatitis are described. In each patient, preoperative examinations revealed a large stone obstructing the main duct in the head of the pancreas. Lateral pancreaticojejunostomy was performed to relieve pain and prevent further attacks of pancreatitis. During each operation, the stone was fragmented under direct visual control with the use of a flexible choledochoscope and a contact electrohydraulic lithotriptor. The stone was removed and ductal flow through the head of the pancreas was reestablished. Our experience shows that endoscopic electrohydraulic lithotripsy facilitates operative removal of pancreatic stones deeply located in the head of the pancreas.
Collapse
Affiliation(s)
- M Tanaka
- Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan
| | | | | | | | | | | |
Collapse
|
|
38
|
Affiliation(s)
- P Watanapa
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
| | | |
Collapse
|
|
39
|
Abstract
Extracorporeal shock-wave lithotripsy (ESWL) has been used to disintegrate pancreatic stones located in the main pancreatic duct for 123 patients with severe chronic pancreatitis. Endoscopic management following ESWL is aimed at restoring the pancreatic flow to the duodenum. Stone disintegration was achieved in 122 patients, whereas a decrease in the main pancreatic duct diameter resulted in 111, and complete clearance of the main pancreatic duct was obtained in 72. Pain relief, complete (40/88) or partial (35/88), correlated significantly with the results of the endoscopic drainage of the main pancreatic duct (e.g., decrease in main pancreatic duct diameter). Relapsing pain was most often related to recurrent pancreatic duct obstruction. Of 76 patients whose body weight had decreased before ESWL, 54 gained weight. Improvement of the exocrine function, evaluated by the [14C]triolein breath test before and 11 months, on the average, after ESWL, was observed in 12 patients among 22 for whom this test was performed before and after treatment. Improvement of the endocrine function after relief of obstruction of the main pancreatic duct was less frequently recorded (4/41). ESWL of pancreatic stones is a new, safe, and highly effective method of facilitating the endoscopic procedures for relief of pancreatic duct obstruction in severe chronic pancreatitis.
Collapse
Affiliation(s)
- M Delhaye
- Medicosurgical Department of Gastroenterology, Erasme Hospital, Free University of Brussels, Belgium
| | | | | | | |
Collapse
|
|
40
|
Sherman S, Lehman GA, Hawes RH, Ponich T, Miller LS, Cohen LB, Kortan P, Haber GB. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc 1991; 37:511-7. [PMID: 1936826 DOI: 10.1016/s0016-5107(91)70818-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pancreatic ductal stones may be responsible for attacks of acute pancreatitis (chronic relapsing pancreatitis) or exacerbations of chronic pain in patients with chronic pancreatitis. This study was undertaken to identify those patients with predominantly main pancreatic duct stones most amenable to endoscopic removal and to determine the effects on the patients' clinical course with such removal. Thirty-two patients with ductographic evidence of chronic pancreatitis and pancreatic duct stones underwent attempted endoscopic removal. Of the patients, 71.9% had complete or partial stone removal and 67.7% improved after endoscopic therapy. Symptomatic improvement was most evident in the group of patients with chronic relapsing pancreatitis. Factors favoring stone removal included (1) three or less stones, (2) stones confined to the head and/or body of the pancreas, (3) absence of a downstream stricture, (4) stone diameter less than or equal to 10 mm, and (5) absence of impacted stones. After successful stone removal, 25% of patients had regression of the ductographic changes of chronic pancreatitis and 41.7% had a decrease in the main pancreatic duct diameter. The only complication from therapy was mild pancreatitis in 8.2%. These data suggest that removal of pancreatic duct stones may result in symptomatic improvement. A longer follow-up will be necessary to determine whether endoscopic success results in long-standing clinical improvement and/or permanent regression of the morphologic changes of chronic pancreatitis.
Collapse
Affiliation(s)
- S Sherman
- Department of Medicine, Indiana University Medical Center, Indianapolis
| | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Kurdziel JC, Dondelinger RF, Barthelme G. Percutaneous transgastric internal drainage, endoscopy and stenting of the pancreatic duct; a new technique. Eur J Radiol 1991; 12:1-3. [PMID: 1999202 DOI: 10.1016/0720-048x(91)90123-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J C Kurdziel
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier, Luxembourg
| | | | | |
Collapse
|
|
42
|
|
|
43
|
Abstract
Pancreatic duct stents have recently been placed for a variety of acute and chronic pancreatic lesions. Although complications have occurred, there are no data to suggest that the stents themselves induce ductal changes. In a retrospective review of 34 patients having 38 pancreatic duct stents placed for disrupted ducts, isolated strictures, pancrease divisum, and hypertensive pancreatic sphincters, 36% of all patients (72% of patients who had normal initial pancreatograms) were found to have subsequent ductal changes. Such changes were related either to stent occlusion (pseudocyst, diffuse duct enlargement) and direct stent trauma or side branch occlusion (irregular stenoses, side branch ectasia). Whereas the former resolved with stent retrieval or exchange, it remains uncertain what the long-term consequences of the latter changes will be, despite a tendency for the abnormal pancreatograms to improve with time. Further experience is needed with pancreatic stenting before widespread application of this technique.
Collapse
Affiliation(s)
- R A Kozarek
- Section of Therapeutic Endoscopy, Virginia Mason Clinic, Seattle, Washington 98111
| |
Collapse
|
|
44
|
Abstract
Between April 1982 and March 1988, 25 patients with chronic pancreatitis presented with biliary stenosis and significant cholestasis. They were treated by endoprosthesis placement. Nineteen patients had jaundice, and, initially, seven had cholangitis (including three with hepatic abscesses). ERCP was successful in all 25 patients. Cholangitis, cholestasis, and jaundice resolved in all cases after stent placement. Two patients died in the 2 months after treatment. Complete follow-up (mean duration, 14 months, range 7 to 42 months) was available for 19 of the 23 remaining patients. Migration of the stent occurred in 10 patients and stent blockage in 8 patients, with relapsing cholestasis (N = 12), cholangitis (N = 4), or without symptoms (N = 2). Only three of these patients are now asymptomatic without a stent in place after 12 to 72 months. In all of the other cases, stents have been replaced or patients have been treated by surgery. We conclude that endoscopic biliary drainage is an effective treatment for resolving cholangitis or jaundice in patients with chronic pancreatitis and biliary stenosis, but that the results of definitive endoscopic drainage for these patients are less satisfactory because resolution of the stricture after removal of the stent is rarely obtained.
Collapse
Affiliation(s)
- J Devière
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | | | | | | |
Collapse
|
|
45
|
Dohmoto M. Management of chronic pancreatitis with pancreas cyst by endoscopic pancreatic prosthesis. Surg Endosc 1990; 4:83-7. [PMID: 1695768 DOI: 10.1007/bf00591264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cases of chronic pancreatitis accompanied by stenosis or dilation of the pancreatic duct were treated by endoscopic placement of an endoprosthesis and drainage. The purpose of the treatment was the alleviation of pain, restoration of extrapancreatic secretion and retardation of the progression of inflammation. The procedure was performed successfully in 9 of 13 patients, using an endoscopically placed pigtail prosthesis in the pancreatic duct. The successfully treated patients consisted of 9 cases of chronic pancreatitis, 2 cases being pancreas divisum. After disappearance of the symptoms and abnormal endoscopic findings, the drainage tubes were removed after a period of 5-12 months. No serious complications were encountered. Following the procedure, an improvement in appetite and increase of 2-13 kg in body weight was recognized. This method yielded satisfactory results in the treatment of chronic pancreatitis.
Collapse
Affiliation(s)
- M Dohmoto
- Klinik für Chirurgie, Medizinischen Universität, Lübeck, Federal Republic of Germany
| |
Collapse
|
|
46
|
Cremer M, Deviere J, Delhaye M, Vandermeeren A, Baize M. Non-surgical management of severe chronic pancreatitis. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1990; 175:77-84. [PMID: 2237284 DOI: 10.3109/00365529009093130] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The observation that drainage of the MPD in selected cases of severe chronic pancreatitis has a radical benefit on pain reduction supports the hypothesis that pain is mainly due to obstruction of the MPD. Further follow-up study is needed to assess whether endoscopic management can prevent progression of the disease and especially postpone the onset of diabetes and steatorrhea. The iterative character of the endoscopic management is at least an advantage when compared with surgery, which, in principle, might be considered definitive in only one operation. The present excellent results of non-surgical management of chronic pancreatitis suggest that these new procedures will find a prominent role similar to that already achieved for biliary tract procedures. Therapeutic endoscopy of the pancreas and chronic pancreatitis has focused on the 'stone and stricture' nature of the disease, and techniques have developed accordingly.
Collapse
Affiliation(s)
- M Cremer
- Erasme Hospital, Brussels Free University, Belgium
| | | | | | | | | |
Collapse
|
|
47
|
Abstract
Extracorporeal shock wave lithotripsy of pancreatic stones was performed in eight patients with chronic pancreatitis and a dilated duct system harbouring stones 5 to 20 mm (means 10 (SD) 5 mm) in diameter. After endoscopic sphincterotomy of the pancreatic orifice the stones were disintegrated by shock waves under fluoroscopic control using a kidney lithotripter (Dornier HM3). The procedure was well tolerated by all but one patient, who had a mild pancreatitic attack immediately after lithotripsy. Clearance of the pancreatic duct systems from the larger stones was achieved in seven of eight patients. Half of the patients showed no improvement in the intensity and frequency of pain. The other patients had a marked amelioration of symptoms, however, both immediately and during a mean follow up interval of 11 (eight) months. A selective combined approach by endoscopy and extracorporeal shock wave lithotripsy for the treatment of pancreatic stones seems promising.
Collapse
Affiliation(s)
- T Sauerbruch
- Medical Department II, Klinikum Grosshadern, University of Munich, Federal Republic of Germany
| | | | | | | |
Collapse
|
|
48
|
Affiliation(s)
- M A Harrison
- Division of Gastroenterology, University of Wisconsin, Madison
| | | |
Collapse
|
|
49
|
Endoscopic Retrograde Cholangiopancreatography in Chronic Pancreatitis. Radiol Clin North Am 1989. [DOI: 10.1016/s0033-8389(22)02117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
|
50
|
Abstract
A nasopancreatic drain, pancreatic duct endoprostheses, and pancreatic stone extraction were used to treat 32 patients with chronic pancreatitis. Thirty patients were treated endoscopically. Endoscopic treatment via the minor papilla in 2 patients with pancreas divisum was not performed. Three patients had subsequent surgery because of complications; one of them died. Seventeen patients with chronic relapsing pancreatitis improved, with 15 patients asymptomatic during a follow-up of 2 to 69 months (median, 11). Seven of 10 patients with chronic pain improved, with 6 patients pain-free during a follow-up of 10 to 34 months (median, 11). In 7 patients, pancreatic pseudocysts could be drained endoscopically by positioning an endoprosthesis into the cyst or by performing a cystoduodenostomy. Six patients had concomitant placement of a biliary endoprosthesis to treat common bile duct strictures within the pancreatic head. One of 32 treated patients died as a result of a complication. We consider endoscopic therapy a viable alternative to surgery in select patients with chronic pancreatitis.
Collapse
Affiliation(s)
- K Huibregtse
- Department of Gastro-Entero-Hepatology, University of Amsterdam, The Netherlands
| | | | | | | |
Collapse
|