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1
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Rainho A, Sridharan M, Strand DS. Pancreatic necrosis: a scoping review. Minerva Gastroenterol (Torino) 2025; 71:48-64. [PMID: 39480250 DOI: 10.23736/s2724-5985.24.03658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]
Abstract
Acute pancreatitis (AP) is a commonly encountered GI diagnosis, accounting for 275,000 hospital admissions annually in the United States alone. Pancreatic necrosis (PN) is the most common complication of AP, and the development of PN is associated with significant morbidity and increased mortality. This expert review evaluates the evidence-based management of symptomatic PN from the era of maximal open pancreatic necrosectomy in the late 1990s though the modern paradigm of minimally invasive and endoscopic interventions. The authors present the retrospective and controlled data behind the "step-up approach" to PN treatment and discuss the application of current society guidance. Evidence based management of PN is characterized by early supportive care, and treatment by minimally invasive intervention when a patient is critically ill or persistently symptomatic. Appropriate choices when intervention is required include percutaneous drainage, minimally invasive surgery, and/or endoscopic treatment. The transition from open maximal necrosectomy to minimally invasive intervention has resulted in improved outcomes for patients, including gains in mortality, significant morbidity, and cost. The ideal precision management strategy for an individual patient remains an area of increasing understanding.
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Affiliation(s)
- Anthony Rainho
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Mira Sridharan
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA -
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2
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Isayama H, Nakai Y, Matsuda K, Kanno Y, Hara K, Ogura T, Abe N, Katanuma A, Kitano M, Yasuda I, Okano N, Tsuchiya T, Fujita N, Inui K, Ueki T, Irisawa A, Yamano HO. Proposal of classification and terminology of interventional endoscopic ultrasonography/endosonography. Dig Endosc 2025; 37:5-17. [PMID: 39364550 DOI: 10.1111/den.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/25/2024] [Indexed: 10/05/2024]
Abstract
Interventional endoscopic ultrasonography/endosongraphy (I-EUS) procedures have rapidly evolved since their introduction three decades ago; however, the classification and terminology for these procedures remain unstandardized. To address this, the Subcommittee for Terminology of I-EUS in the Japan Gastroenterological Endoscopy Society was established to define classifications and a glossary of I-EUS terms. They categorized I-EUS procedures into five types based on purpose and method: (i) EUS-guided sampling; (ii) EUS-guided through-the-needle examination; (iii) EUS-guided drainage/anastomosis (EUS-D/A); (iv) trans-endosonographically/EUS-guided created route (ESCR) procedures; and (v) EUS-guided delivery. EUS-guided sampling includes tissue acquisition and fluid sampling, classified by needle type into fine needle aspiration and fine needle biopsy. Through-the-needle examinations include imaging, measurements, and biopsies. EUS-D/A includes organ drainage/anastomosis, fluid collection drainage, and digestive tract anastomosis. In the EUS-D/A route, "anastomosis" is used for organ-to-organ procedures, whereas "tract" is for fluid drainage. ESCR is a newly proposed term for procedures via anastomosis or tract, such as endoscopic necrosectomy and EUS-guided antegrade stenting. The term "trans-luminal drainage/anastomosis stent" is used for stents that maintain the ESCR rather than treating strictures. EUS-guided delivery involves the delivery of substances, such as fluids, drugs, medical devices, and energy. This proposed categorization and terminology aimed to clarify I-EUS procedures and will require updates as new techniques and concepts emerge.
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Affiliation(s)
| | - Yousuke Nakai
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Koji Matsuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Kazuo Hara
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takeshi Ogura
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Nobutsugu Abe
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ichiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naoki Okano
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kazuo Inui
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshiharu Ueki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hiro-O Yamano
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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3
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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.
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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.
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4
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Takahashi K, Ohyama H, Ohno I, Kato N. Tardive Peritonitis After Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage: A Case Report. Cureus 2024; 16:e60179. [PMID: 38868273 PMCID: PMC11167511 DOI: 10.7759/cureus.60179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Here, we report a case of tardive peritonitis after endoscopic ultrasound (EUS)-guided transmural pancreatic pseudocyst drainage. A 50-year-old man was diagnosed with acute pancreatitis and a pancreatic pseudocyst measuring 5 cm. Ten months later, his pancreatic pseudocyst was 10 cm. We performed EUS-guided transmural drainage using a lumen-apposing metal stent. After two months, the stent was replaced with a double-pigtail plastic stent. Two months later, the patient developed fever and abdominal pain, and computed tomography revealed abdominal free air. He was diagnosed with peritonitis due to free air caused by a fistula rupture. The double-pigtail plastic stent was removed, and clipping was performed at the fistula site to achieve closure. The patient's symptoms subsequently improved. Long-term placement of a plastic stent for pancreatic pseudocysts makes recurrence less likely, but late adverse events due to stent placement can occur. Notably, fistula rupture can occur even when the fistula is well-formed several months after the initial drainage.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Chiba University, Chiba, JPN
- Department of Medical Oncology, Chiba University, Chiba, JPN
| | - Hiroshi Ohyama
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Izumi Ohno
- Department of Gastroenterology, Chiba University, Chiba, JPN
- Department of Medical Oncology, Chiba University, Chiba, JPN
| | - Naoya Kato
- Department of Gastroenterology, Chiba University, Chiba, JPN
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5
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Schulman AR, Howell JD. From Hirschowitz to 2023: Modern Endoscopy and Beyond. Clin Gastroenterol Hepatol 2024; 22:684-688. [PMID: 38056802 DOI: 10.1016/j.cgh.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joel D Howell
- Departments of Internal Medicine and History, University of Michigan, Michigan, Ann Arbor
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6
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Binda C, Fabbri S, Perini B, Boschetti M, Coluccio C, Giuffrida P, Gibiino G, Petraroli C, Fabbri C. Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:333. [PMID: 38399620 PMCID: PMC10890047 DOI: 10.3390/medicina60020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5, 45100 Rovigo, Italy
| | - Martina Boschetti
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Chiara Petraroli
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, Italy
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7
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Gilman AJ, Baron TH. Endoscopic Necrosectomy. Gastrointest Endosc Clin N Am 2023; 33:709-724. [PMID: 37709406 DOI: 10.1016/j.giec.2023.04.010] [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
The management of walled-off necrosis has evolved substantially over the past 23 years since its first description. In this article, we review its history and the evidence supporting modern treatment, which is still subject to heterogeneity across centers and among endoscopists. This allows for creativity and customization of what can be an endoscopic marathon. Our typical practice is discussed with image and video guides aimed at improving procedure success.
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Affiliation(s)
- Andrew J Gilman
- Division of Gastroenterology & Hepatology, University of North Carolina, 130 Mason Farm Road, Bioinformatics Building CB# 7080, Chapel Hill, NC 27599-7080, USA. https://twitter.com/a_gilman
| | - Todd H Baron
- Division of Gastroenterology & Hepatology, University of North Carolina, 130 Mason Farm Road, Bioinformatics Building CB# 7080, Chapel Hill, NC 27599-7080, USA.
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8
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Tanikawa T, Kawada M, Ishii K, Urata N, Nishino K, Suehiro M, Kawanaka M, Haruma K, Kawamoto H. Efficacy of endoscopic ultrasound-guided abscess drainage for non-pancreatic abscesses: A retrospective study. JGH Open 2023; 7:470-475. [PMID: 37496811 PMCID: PMC10366484 DOI: 10.1002/jgh3.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND AND AIM Percutaneous drainage of intra-abdominal abscesses is often uncomfortable for the patient and may result in prolonged hospital stays. Recent studies have shown that endoscopic ultrasound-guided abscess drainage (EUS-AD) could effectively treat various abscesses and fluid collections. However, no indications or procedures have been established for EUS-AD treatments, and studies on its usefulness and safety are insufficient. The present study aimed to evaluate the efficacy and safety of EUS-AD for treating non-pancreatic abscesses. METHODS This retrospective study included 20 patients, aged ≥20 years, who underwent EUS-AD for an abscess or fluid accumulation in the abdomen or mediastinum, but not the pancreas. Patients were treated at the Kawasaki University General Medical Center between March 2013 and June 2021. All EUS-AD procedures were performed prior to a percutaneous drainage or surgical drainage. RESULTS Among the 20 patients who underwent an EUS-AD for abscess, 8 (40%) had liver abscesses, 6 (30%) had intraperitoneal abscesses, 3 had (15%) splenic abscesses, 1 (5%) had a mediastinal abscess, 1 (5%) had an iliopsoas abscess (n = 1, 5%), and 1 (5%) had an abdominal wall abscess. The technical success rate was 95% (n = 19/20). We inserted nasobiliary catheters in 4/20 patients (20%). The clinical success rate was 90% (n = 18/20). Two clinical failures required reintervention, and both were treated with percutaneous drainage. Adverse events were observed in 2/20 patients (10%). One patient experienced fever after the procedure, and the other experienced localized peritonitis. CONCLUSION EUS-AD was effective and safe for abscess removal, particularly when approached from the upper gastrointestinal tract.
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Affiliation(s)
- Tomohiro Tanikawa
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Mayuko Kawada
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Katsunori Ishii
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Noriyo Urata
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Nishino
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Miwa Kawanaka
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Ken Haruma
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
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Zeng Y, Yang J, Zhang JW. Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges. World J Clin Cases 2023; 11:1888-1902. [PMID: 36998953 PMCID: PMC10044952 DOI: 10.12998/wjcc.v11.i9.1888] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Infected necrotizing pancreatitis (INP) represents a severe condition in patients with acute pancreatitis. Invasive interventions are recommended in symptomatic INP. Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures. However, there is still no standardized protocol for endoscopic interventions. Recently, various studies have been published about the endoscopic management of INP. This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.
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Affiliation(s)
- Yan Zeng
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian Yang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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10
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Iwashita T, Iwata K, Hamada T, Saito T, Shiomi H, Takenaka M, Maruta A, Uemura S, Masuda A, Matsubara S, Mukai T, Takahashi S, Hayashi N, Isayama H, Yasuda I, Nakai Y. Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future perspectives. J Gastroenterol 2023; 58:98-111. [PMID: 36342540 DOI: 10.1007/s00535-022-01935-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
Pancreatic fluid collections (PFCs) commonly develop as complications of acute pancreatitis and ductal disruption due to chronic pancreatitis. In the revised Atlanta classification, PFCs were classified based on the presence of necrosis and duration following the onset of acute pancreatitis. Interventions are required in cases of symptomatic pancreatic pseudocysts or walled-off necrosis (WON). In the management of these PFCs, endoscopic ultrasound-guided transluminal drainage and subsequent direct endoscopic necrosectomy for WON are increasingly utilized as less invasive treatment modalities compared to surgical debridement. To date, researchers have focused predominantly on the technical aspects of endoscopic therapy for symptomatic PFCs. Given the poor physical condition of patients receiving endoscopic treatment for PFCs, systemic support may have a substantial impact on the short- and long-term outcomes of these patients. A multidisciplinary approach is required to improve the clinical outcomes of patients with infected PFCs and their associated comorbidities. However, non-interventional support during the periprocedural period of endoscopic treatment of PFCs has not been fully discussed, and there have been considerable variations in the selection of treatment options between endoscopists and centers. To address these unmet needs in the clinical management of PFCs and promote future research to improve the clinical outcomes, we conducted a review of the literature within a multicenter consortium of expert endoscopists with specific expertise in the endoscopic treatment of PFCs. In this review, we summarize the current evidence on non-interventional supportive care (e.g., continuous lavage, medications, nutritional support, and antimicrobials) and propose potential topics for future research.
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Akinori Maruta
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Saburo Matsubara
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Sho Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Nobuhiko Hayashi
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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11
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Woo DH, Lee JH, Park YJ, Lee WH, Song KB, Hwang DW, Kim SC. Comparison of endoscopic ultrasound-guided drainage and percutaneous catheter drainage of postoperative fluid collection after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg 2022; 26:355-362. [PMID: 36003001 PMCID: PMC9721245 DOI: 10.14701/ahbps.22-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
Backgrounds/Aims Postoperative fluid collection is a common complication of pancreatic resection without clear management guidelines. This study aimed to compare outcomes of endoscopic ultrasound (EUS)-guided trans-gastric drainage and percutaneous catheter drainage (PCD) in patients who experienced this adverse event after pancreaticoduodenectomy (PD). Methods Demographic and clinical data and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for fluid collection after PD between January 2015 and June 2019 in our tertiary referral center were retrospectively analyzed. Results Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (69.8%), and nausea/vomiting (17.0%). Within 8 weeks of drainage, 77.4% showed a diameter decrease of more than 50% (87.5% in EUS vs. 66.7% in PCD, p = 0.09). Post-procedural intravenous antibiotics were used for an average of 8.1 ± 4.3 days and 12.4 ± 7.4 days for EUS group and PCD group, respectively (p = 0.01). The EUS group had a shorter post-procedural hospital stay than the PCD group (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p < 0.01). However, the two groups showed no statistically significant difference in technical or clinical success rate, reintervention rate, or adverse event rate. Conclusions EUS-guided drainage and PCD are both safe and effective methods for managing fluid collection after PD. However, EUS-guided drainage can shorten hospital stay and duration of intravenous antibiotics use.
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Affiliation(s)
- Da Hee Woo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author: Jae Hoon Lee, MD, PhD Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-1521, Fax: +82-2-3010-6701, E-mail: ORCID: https://orcid.org/0000-0002-6170-8729
| | - Ye Jong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Hyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Takada T, Isaji S, Mayumi T, Yoshida M, Takeyama Y, Itoi T, Sano K, Iizawa Y, Masamune A, Hirota M, Okamoto K, Inoue D, Kitamura N, Mori Y, Mukai S, Kiriyama S, Shirai K, Tsuchiya A, Higuchi R, Hirashita T. JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1057-1083. [PMID: 35388634 DOI: 10.1002/jhbp.1146] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In preparing the Japanese (JPN) guidelines for the management of acute pancreatitis 2021, the committee focused the issues raised by the results of nationwide epidemiological survey in 2016 in Japan. METHOD In addition to a systematic search using the previous JPN guidelines, papers published from January 2014 to September 2019 were searched for the contents to be covered by the guidelines based on the concept of GRADE system. RESULTS Thirty-six clinical questions (CQ) were prepared in 15 subject areas. Based on the facts that patients diagnosed with severe disease by both Japanese prognostic factor score and contrast-enhanced computed tomography (CT) grade had a high fatality rate and that little prognosis improvement after 2 weeks of disease onset was not obtained, we emphasized the importance of Pancreatitis Bundles, which were shown to be effective in improving prognosis, and the CQ sections for local pancreatic complications had been expanded to ensure adoption of a step-up approach. Furthermore, on the facts that enteral nutrition for severe acute pancreatitis was not started early within 48 h of admission and that unnecessary prophylactic antibiotics was used in almost all cases, we emphasized early enteral nutrition in small amounts even if gastric feeding is used and no prophylactic antibiotics are administered in mild pancreatitis. CONCLUSION All the members of the committee have put a lot of effort into preparing the extensively revised guidelines in the hope that more people will have a common understanding and that better medical care will be spread.
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Affiliation(s)
- Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Isaji
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health & Welfare, Chiba, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Iizawa
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Hospital, Ishikawa, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Yasuhisa Mori
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Kunihiro Shirai
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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13
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Minaga K, Kudo M. Connected or disconnected: What's next after successful transmural drainage of pancreatic fluid collection? Dig Endosc 2022; 34:1242-1244. [PMID: 35645001 DOI: 10.1111/den.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/03/2022] [Accepted: 04/15/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
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14
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Xia C, Yin H, Zhang K, Wang Z, Yang X, Huang H. The global research status and trends of the application of endoscopic ultrasonography in pancreatic tumors over the last decades: A bibliometric study. Front Oncol 2022; 12:980415. [PMID: 36033532 PMCID: PMC9411717 DOI: 10.3389/fonc.2022.980415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background To describe the development process and structural relationships of scientific achievements in endoscopic ultrasonography (EUS) in pancreatic tumors over the past decades and to reveal the key research topics using bibliometric analysis. Methods All relevant publications covering the research of EUS in pancreatic tumors from 1984 to 2021 were involved through the Web of Science Core Collection. R-bibliometrix was used to conduct the bibliometric analysis, and VOSviewer software was used to explore the hot spots and networks related to this field. Results Between 1984 and 2021, 4071 publications were involved. The number of annual publications increased from 1 to 310. The United States contributed the most publications to this field (n=1433, 35.20%), followed by Japan (n=827, 20.31%) and Germany (n=319, 7.84%). There was active cooperation between countries/regions. Gastrointestinal Endoscopy (GIE) was the most productive journal and the most influential journal. Professor Giovannini M, who produced the most publications, had a great influence on this research. The focus in this field was clarified by analyzing the top 10 citations and co-citations publications. Moreover, the analysis of the keywords showed Important topics: "Classification of pancreatic tumor disease" "Development of EUS in the diagnosis of pancreatic tumor diseases," and "Development of EUS in the treatment of pancreatic tumor diseases." Conclusion For the first time, bibliometric analysis was used to gain a deep understanding of the global trends of studies investigating EUS in pancreatic tumor diseases. The EUS field is rapidly evolving, and our study may be a critical reference for clinical researchers related to this field.
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Affiliation(s)
- Chuanchao Xia
- Department of Gastroenterology, First Affiliated Hospital, Naval Medical University, Shanghai, China
| | - Hua Yin
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Kecheng Zhang
- Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Zhenhuan Wang
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Xiaoli Yang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haojie Huang
- Department of Gastroenterology, First Affiliated Hospital, Naval Medical University, Shanghai, China
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15
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Bhakta D, de Latour R, Khanna L. Management of pancreatic fluid collections. Transl Gastroenterol Hepatol 2022; 7:17. [PMID: 35548474 PMCID: PMC9081921 DOI: 10.21037/tgh-2020-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2023] Open
Abstract
Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).
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Affiliation(s)
- Dimpal Bhakta
- New York University School of Medicine, New York, USA
| | | | - Lauren Khanna
- New York University School of Medicine, New York, USA
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16
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Hentschel V, Walter B, Harder N, Arnold F, Seufferlein T, Wagner M, Müller M, Kleger A. Microbial Spectra and Clinical Outcomes from Endoscopically Drained Pancreatic Fluid Collections: A Descriptive Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11030420. [PMID: 35326883 PMCID: PMC8944472 DOI: 10.3390/antibiotics11030420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/12/2022] [Indexed: 12/10/2022] Open
Abstract
Pancreatic pseudocyst (PC) and walled-off necrosis (WON) are dreaded complications of acute pancreatitis. Standard therapy consists of endoscopic ultrasound-guided transmural placement of stents to expedite resolution through internal drainage of fluids or necrotic material. Either double pigtail plastic stents (DPPS) or lumen-apposing metal stents (LAMS), or a combination of both, are available for this purpose. The objective of this study was to examine the impact of different stent types on infection rates in addition to clinical outcome measures such as periprocedural adverse events. We conducted a retrospective study comprising 77 patients who had undergone endoscopic drainage for PC or WON in a pancreatitis tertiary referral center. Analysis revealed that both bacterial and fungal infections occurred more frequently in patients treated with LAMS with or without DPPS compared to DPPS only. The use of antibiotics and antimycotics followed the same pattern. Furthermore, a prolonged length of hospital stay and a higher likelihood of transfer to an intermediate care unit were observed in patients with LAMS with or without DPPS. These differences were eliminated if only WON patients were analyzed. Our data imply that the clinical course is primarily influenced by the complexity of the pancreatic fluid collection (PFC) itself rather than the stent type. Prospective large-scale cohort studies are mandatory to underpin these findings.
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Affiliation(s)
- Viktoria Hentschel
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Benjamin Walter
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Noemi Harder
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
| | - Frank Arnold
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
| | - Thomas Seufferlein
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Martin Wagner
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Martin Müller
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Alexander Kleger
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-5000
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17
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Pinto S, Bellizzi S, Badas R, Canfora ML, Loddo E, Spada S, Khalaf K, Fugazza A, Bergamini S. Direct Endoscopic Necrosectomy: Timing and Technique. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121305. [PMID: 34946249 PMCID: PMC8707414 DOI: 10.3390/medicina57121305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.
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Affiliation(s)
- Sergio Pinto
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
- Correspondence: ; Tel.: +39-07051096423
| | - Saverio Bellizzi
- Medical Epidemiologist, Independent Consultant, 1202 Geneva, Switzerland;
| | - Roberta Badas
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
| | - Maria Laura Canfora
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
| | - Erica Loddo
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
| | - Simone Spada
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milano, Italy;
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital-IRCCS, 20089 Rozzano, Italy;
| | - Silvio Bergamini
- Digestive Endoscopy Unit, Department of Surgical Sciences, University Hospital of Cagliari, 09042 Cagliari, Italy; (R.B.); (M.L.C.); (E.L.); (S.S.); (S.B.)
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18
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Jagielski M, Jackowski M. The Role of Lumen-Apposing Metal Stents in Transmural Endoscopic Drainage of Postinflammatory Pancreatic and Peripancreatic Fluid Collections. Gastroenterol Res Pract 2021; 2021:4351151. [PMID: 34691174 PMCID: PMC8528637 DOI: 10.1155/2021/4351151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/23/2021] [Indexed: 12/14/2022] Open
Abstract
Rapid development of advanced gastrointestinal endoscopic techniques contributed to the appearance of new biomedical materials including polymers, which are used for the production of different types of endoprostheses. Endotherapy (ET) of postinflammatory pancreatic and peripancreatic fluid collections (PPFCs) with the use of lumen-apposing metal stent (LAMS) is an effective method of treatment. This paper describes the high efficacy of ET and its potential complications, which are mostly related to the design of the LAMS used. The high efficacy of LAMS in the transmural drainage of PPFCs is associated with lower safety of treatment. Complications of ET presented in the manuscript are mainly related to endoprosthesis' construction. This paper presents possible directions of development in the field of transmural LAMSs, which in the future may contribute to the invention of an innovative type of LAMS based on new biomedical technologies. Possibly, subsequent novel endoprosthesis projects, based on the above results, will be able to meet the current needs and requirements associated with endoscopic transmural drainage procedures in cases of postinflammatory PPFCs. The ultimate goal is to improve safety of minimally invasive techniques for treatment of the local consequences of pancreatitis.
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Affiliation(s)
- Mateusz Jagielski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - Marek Jackowski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
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19
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Yasuda I, Takahashi K. Endoscopic management of walled-off pancreatic necrosis. Dig Endosc 2021; 33:335-341. [PMID: 32306430 DOI: 10.1111/den.13699] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
Walled-off pancreatic necrosis (WON) can develop in the late phase of necrotizing pancreatitis. When the WON is accompanied by an infection in the necrotic bed, it becomes a life-threatening complication. Open necrosectomy with drainage has been the standard treatment; however, it is associated with a significant morbidity and high mortality. Therefore, minimally invasive therapeutic alternatives are in demand. Recently, a new treatment algorithm for necrotizing pancreatitis, known as the step-up approach, has been proposed. The initial report on it consisted of percutaneous drainage followed by, if necessary, a minimally invasive retroperitoneal necrosectomy. However, the endoscopic step-up approach, which consists of EUS-guided transluminal drainage followed by, if necessary, endoscopic necrosectomy, was later introduced. Recent studies have suggested that an endoscopic step-up approach might be more advantageous than a minimally invasive surgical step-up approach. A lumen apposing metal stent (LAMS) with a cautery-enhanced delivery system is currently preferred over the conventional plastic stents for endoscopic interventions, because it decreases the technical difficulty of the procedure and may obviate the need for an adjunctive debridement procedure. However, some recent findings suggest that LAMS could be associated with a higher risk of stent-related complications than conventional plastic stents, especially in patients with long-term placement. Therefore, early removal of LAMS at 3 weeks post-intervention is proposed if the WON is resolved on CT examination. Thus, endoscopic interventions have emerged as a key player in the management of WON. However, multidisciplinary treatment approaches should be considered because the endoscopic approach has limitations in treating complicated WON.
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Affiliation(s)
- Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kosuke Takahashi
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
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20
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Dorrell R, Pawa S, Pawa R. Endoscopic Management of Pancreatic Fluid Collections. J Clin Med 2021; 10:jcm10020284. [PMID: 33466752 PMCID: PMC7835868 DOI: 10.3390/jcm10020284] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Pancreatic fluid collections (PFCs) are a common sequela of pancreatitis. Most PFCs can be managed conservatively, but symptomatic PFCs require either surgical, percutaneous, or endoscopic intervention. Recent advances in the therapeutics of PFCs, including the step-up approach, endoscopic ultrasound-guided transmural drainage with lumen apposing metal stents, and direct endoscopic necrosectomy, have ushered endoscopy to the forefront of PFCs management and have allowed for improved patient outcomes and decreased morbidity. In this review, we explore the progress and future of endoscopic management of PFCs.
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Affiliation(s)
- Robert Dorrell
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Swati Pawa
- Department of Medicine, Section of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Rishi Pawa
- Department of Medicine, Section of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
- Correspondence:
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21
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Umapathy C, Gajendran M, Mann R, Boregowda U, Theethira T, Elhanafi S, Perisetti A, Goyal H, Saligram S. Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management. Dis Mon 2020; 66:100986. [PMID: 32312558 DOI: 10.1016/j.disamonth.2020.100986] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.
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Affiliation(s)
- Chandraprakash Umapathy
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, USA
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, TX 79905, USA.
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, 1303 E Herndon Ave, Fresno, CA 93730, USA
| | - Umesha Boregowda
- Department of Internal Medicine, Bassett Healthcare Network, Columbia Bassett Medical School, 1 Atwell Road, Cooperstown, NY 13326, USA
| | - Thimmaiah Theethira
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93721, USA
| | - Sherif Elhanafi
- Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, TX 79905, USA
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hemant Goyal
- The Wright Center of Graduate Medical Education, Scranton, PA, USA
| | - Shreyas Saligram
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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22
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Teoh AYB. Endoscopic ultrasound-guided anastomosis: Is it ready for prime time? J Gastroenterol Hepatol 2020; 35:1288-1293. [PMID: 32415861 DOI: 10.1111/jgh.15099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
Significant advancements in endoscopic ultrasound (EUS)-guided drainage procedures and EUS-guided anastomosis have recently been described. The described procedures include EUS-guided drainage of pancreatic fluid collections, biliary drainage, pancreatic duct drainage, gallbladder drainage, and gastroenterostomy. These procedures have been made possible with novel devices that can reduce the difficulties of the procedures and potentially reducing the risk of adverse events. The procedures are also becoming standardized, which is essential for dissemination of the techniques. Furthermore, results from randomized studies are becoming available showing definite benefits associated with these procedures. In this paper, we will provide a review on EUS-guided anastomotic procedures.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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23
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Tan S, Zhong C, Ren Y, Luo X, Xu J, Peng Y, Fu X, Tang X. Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis. Gastroenterol Res Pract 2020; 2020:4952721. [PMID: 32382266 PMCID: PMC7189322 DOI: 10.1155/2020/4952721] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Recently, a new type of metal stent, named lumen-apposing metal stents (LAMS), has been designed to manage pancreatic fluid collections (PFC), and a few studies have reported its efficacy and safety. Therefore, we conducted this meta-analysis to investigate the role of LAMS for PFC. METHODS We searched the studies from PubMed, MEDLINE, Embase, and Cochrane databases from inception to May 2019. We extracted the data and analyzed the technical success, clinical success, and adverse events of LAMS to evaluate its efficacy and safety. RESULTS Twenty studies with 1534 patients were included. The pooled technical success, clinical success, and adverse event rates of LAMS for PFC were 96.2% (95% confidence interval (CI): 94.6%-97.4%), 86.8% (95% CI: 83.1%-89.8%), and 20.7% (95% CI: 16.1%-26.1%), respectively. Eight studies including 875 patients compared the clinical outcomes of LAMS with plastic stents. The pooled risk ratio (RR) of technical success and clinical success for LAMS and plastic stent was 1.01 (95% CI: 0.98-1.04, P = 0.62) and 1.06 (95% CI: 1.01-1.12, P = 0.03), respectively. As for the overall adverse events, the pooled RR was 1.51 (95% CI: 0.67-3.44, P = 0.32). CONCLUSIONS Our current study revealed that LAMS has advantages over plastic stents for PFC, with higher clinical success rate and lower complication rate of infection and occlusion.
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Affiliation(s)
- Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yutang Ren
- Department of Gastroenterology, The People's Hospital of Lianshui, Huaian, China
| | - Xujuan Luo
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jin Xu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiangsheng Fu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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24
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Takeishi K, Yoshizumi T, Ikegami T, Itoh S, Harada N, Fujimori N, Ohno T, Mori M. Transgastric Endoscopic Lumen-Apposing Metal Stents for Intra-abdominal Fluid Collections After Living Donor Liver Transplantation. Liver Transpl 2020; 26:598-601. [PMID: 31869521 DOI: 10.1002/lt.25707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/30/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamasa Ohno
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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25
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Furnari M, Telese A, Hann A, Lisotti A, Boškoski I, Eusebi LH. New Devices for Endoscopic Treatments in Gastroenterology: A Narrative Review. Curr Drug Metab 2020; 21:850-865. [PMID: 32703127 DOI: 10.2174/1389200221666200722145727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/07/2022]
Abstract
Endoscopy is in a period of continuous innovations in terms of image quality, endoscopes, post-processing software and lastly, application of Artificial Intelligence. Therapeutic boundaries have expanded, widening the grey zone between endoscopy and surgery, and increasing endoscopic approaches in clinical scenarios where, until a few years ago, surgery was the only option. New scopes and accessories have made it easier to access critical areas such as the biliary tree and the small bowel intestine. In the field of hepato-pancreato-biliary endoscopy (HPB), it is now possible to directly access the biliary ducts or cystic lesions though dedicated stents and scopes, rather than having to rely only on fluoroscopy and ultrasound, increasing the diagnostic and therapeutic options by applying a three-dimensional approach. This narrative review will give an overview of some of the most relevant emerging fields in luminal and HPB endoscopy, highlighting advantages and main limitations of the techniques, and providing considerations for future development.
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Affiliation(s)
- Manuele Furnari
- Department of Internal Medicine, Gastroenterology Unit, Policlinico IRCCS "San Martino", University of Genoa, Genoa, Italy
| | - Andrea Telese
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom
| | - Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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26
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Jagielski M, Smoczyński M, Szeliga J, Adrych K, Jackowski M. Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist. J Clin Med 2020; 9:117. [PMID: 31906294 PMCID: PMC7019492 DOI: 10.3390/jcm9010117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional treatment, particularly endoscopy, are still unclear. In this article, we attempt to discuss these aspects and summarize the current knowledge on endoscopic therapy for pancreatic necrosis. Endotherapy has been shown to be a safe and effective minimally invasive treatment modality in patients with consequences of ANP. The evolution of endoscopic techniques has made endoscopic drainage more effective and reduced the use of other minimally invasive therapies for pancreatic necrosis.
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Affiliation(s)
- Mateusz Jagielski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.S.); (M.J.)
| | - Marian Smoczyński
- Department of Gastroenterology and Hepatology, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.S.); (K.A.)
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.S.); (M.J.)
| | - Krystian Adrych
- Department of Gastroenterology and Hepatology, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.S.); (K.A.)
| | - Marek Jackowski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.S.); (M.J.)
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27
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Abstract
EUS-guided biliary drainage (BD) is an option to treat obstructive jaundice when ERCP drainage fails. These procedures represent alternatives to surgery and percutaneous transhepatic BD and have been made possible through the continuous development and improvement of EUS scopes and accessories. The development of linear sectorial array EUS scopes in early 1990 brought a new approach to the diagnostic and therapeutic dimensions of echoendoscopy capabilities, opening the possibility to perform puncture over a direct ultrasonographic view. Despite the high success rate and low morbidity of BD obtained by ERCP, difficulty can arise with an ingrown stent tumor, tumor gut compression, periampullary diverticula, and anatomic variation. The EUS-guided technique requires puncture and contrast of the left biliary tree. When performed from the gastric wall, access is obtained through hepatic segment III. Diathermic dilation of the puncturing tract is performed using a 6F cystotome and a plastic or metallic stent. The technical success of hepaticogastrostomy is near 98%, and complications are present in 15%–20% of cases. The most common complications include pneumoperitoneum, bilioperitoneum, infection, and stent dysfunction. To prevent bile leakage, we used a special partially covered stent (70% covered and 30% uncovered). Over the last 15 years, the technique has typically been performed in reference centers, by groups experienced with ERCP. This seems to be a general guideline for safer execution of the procedure.
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Affiliation(s)
- Marc Giovannini
- Endoscopic Unit, Paoli-Calmettes Institute, Marseille Cedex, France
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28
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Kwon CI, Cho JH, Choi SH, Ko KH, Tirkes T, Gromski MA, Lehman GA. Recent advances in the diagnosis and management of chronic pancreatitis. Korean J Intern Med 2019; 34:242-260. [PMID: 30840807 PMCID: PMC6406102 DOI: 10.3904/kjim.2019.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic pancreatitis is a chronic condition characterized by pancreatic inflammation that causes fibrosis and the destruction of exocrine and endocrine tissues. Chronic pancreatitis is a progressive disease, and no physiological treatment is available to reverse its course. However, with advances in medical technology, the existing diagnostic and treatment methods for chronic pancreatitis are evolving. Managing patients with chronic pancreatitis is challenging and necessitates a multidisciplinary approach. In this review, we discuss the recent advances in the diagnosis and management of chronic pancreatitis and introduce future alternative modalities.
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Affiliation(s)
- Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Hoon Choi
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kwang Hyun Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Temel Tirkes
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark A. Gromski
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen A. Lehman
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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29
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Yoon SB, Chang JH, Lee IS. [Treatment of Pancreatic Fluid Collections]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2018; 72:97-103. [PMID: 30270591 DOI: 10.4166/kjg.2018.72.3.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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30
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Jagielski M, Smoczyński M, Adrych K. Single transluminal gateway transcystic multiple drainage for extensive walled-off pancreatic necrosis - a single-centre experience. PRZEGLAD GASTROENTEROLOGICZNY 2018; 13:242-248. [PMID: 30302171 PMCID: PMC6173077 DOI: 10.5114/pg.2018.78290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/07/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In last three decades we have observed development in minimally invasive techniques in the treatment of walled-off pancreatic necrosis (WOPN). Endoscopic treatment of the consequences of acute necrotising pancreatitis is a accepted and common minimally invasive method. AIM Evaluation of the efficiency and safety of the innovative endoscopic treatment method (single transluminal gateway transcystic multiple drainage - SGTMD) in patients with extensive walled-off pancreatic necrosis. MATERIAL AND METHODS The retrospective analysis of 114 consecutive patients with symptomatic WOPN, who were treated endoscopically in our medical centre between 2011 and 2016. RESULTS Single transluminal gateway transcystic multiple drainage was performed in 21/114 (18.42%) patients. Endoscopic necrosectomy under fluoroscopic guidance was performed in 12/21 (57.14%) patients. Complications of treatment appeared in 7/21 (33.33%) patients. The most common of complication was upper gastrointestinal bleeding treated conservatively with packed red blood cells transfusions. There were no deaths. Therapeutic success was reached in 20/21 (95.24%) patients. No patient required surgery. The medium time of follow-up was 22 months (16-47). During the observation the recurrence of pancreatic fluid collection was noticed in 1/21 (4.76%) patients. Long-term success of endoscopic treatment was achieved in 19/21 (90.47%) patients. CONCLUSIONS Single transluminal gateway transcystic multiple drainage is an effective method of endoscopic treatment for extensive walled-off pancreatic necrosis with an acceptable amount of complications. However, the method of interventional treatment of pancreatic necrosis should depend not only on the location of necrosis, but also on the experience of the medical centre.
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Affiliation(s)
- Mateusz Jagielski
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
| | - Marian Smoczyński
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
| | - Krystian Adrych
- Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland
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31
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Teoh AYB, Dhir V, Kida M, Yasuda I, Jin ZD, Seo DW, Almadi M, Ang TL, Hara K, Hilmi I, Itoi T, Lakhtakia S, Matsuda K, Pausawasdi N, Puri R, Tang RS, Wang HP, Yang AM, Hawes R, Varadarajulu S, Yasuda K, Ho LKY. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67:1209-1228. [PMID: 29463614 DOI: 10.1136/gutjnl-2017-314341] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 12/22/2017] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Interventional endoscopic ultrasonography (EUS) procedures are gaining popularity and the most commonly performed procedures include EUS-guided drainage of pancreatic pseudocyst, EUS-guided biliary drainage, EUS-guided pancreatic duct drainage and EUS-guided celiac plexus ablation. The aim of this paper is to formulate a set of practice guidelines addressing various aspects of the above procedures. METHODS Formulation of the guidelines was based on the best scientific evidence available. The RAND/UCLA appropriateness methodology (RAM) was used. Panellists recruited comprised experts in surgery, interventional EUS, interventional radiology and oncology from 11 countries. Between June 2014 and October 2016, the panellists met in meetings to discuss and vote on the clinical scenarios for each of the interventional EUS procedures in question. RESULTS A total of 15 statements on EUS-guided drainage of pancreatic pseudocyst, 15 statements on EUS-guided biliary drainage, 12 statements on EUS-guided pancreatic duct drainage and 14 statements on EUS-guided celiac plexus ablation were formulated. The statements addressed the indications for the procedures, technical aspects, pre- and post-procedural management, management of complications, and competency and training in the procedures. All statements except one were found to be appropriate. Randomised studies to address clinical questions in a number of aspects of the procedures are urgently required. CONCLUSIONS The current guidelines on interventional EUS procedures are the first published by an endoscopic society. These guidelines provide an in-depth review of the current evidence and standardise the management of the procedures.
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Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Mumbai, Maharashtra, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University Hospital, Sagamihara City, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Zhen Dong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, Seoul, Republic of Korea
| | - Majid Almadi
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ida Hilmi
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Koji Matsuda
- St Marianna University School of Medicine, Yokohama City Seibu Hospital, Kawasaki, Japan
| | - Nonthalee Pausawasdi
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rajesh Puri
- Department of Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta, The Medicity, Gurgaon, India
| | - Raymond S Tang
- Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ai Ming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng-qu, Beijing, China
| | - Robert Hawes
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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32
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Abstract
The lumen-apposing metal stent is the first stent specifically designed for endoscopic ultrasound-guided transluminal drainage of extraintestinal fluid collections. With the "hot" electrocautery-enhanced delivery system, this platform marks the most recent evolutionary stage of endoscopic therapy of pancreatic fluid collections. The lumen-apposing metal stent platform has made endoscopic drainage of pancreatic fluid collections easier and safer, while serving as a port for safe entry into the cyst cavity to extend the reach of endoscopic diagnosis and therapy. Tools conceived for endoscopic ultrasound-guided transluminal intervention have emerged and are opening the door to new frontiers of endoscopic transluminal therapy.
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Affiliation(s)
- Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, Suite 600, San Francisco, CA 94115, USA.
| | - Andrew Nett
- Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, Suite 600, San Francisco, CA 94115, USA
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Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol 2018; 3:18. [PMID: 29682625 DOI: 10.21037/tgh.2018.03.03] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022] Open
Abstract
Pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders. Their management demands the co-operation of surgeons, radiologists and gastroenterologists. Historically, they have been treated either conservatively or surgically, with acceptable rates of complications and recurrence. However, recent advances in radiology and endoscopy, have leaded physicians to implement percutaneous and endoscopic drainage (ED) into their treatment algorithms. Moreover, laparoscopic surgery, with its advantages, has become an attractive alternative choice when surgical drainage (SD) is required. The aim of this review is to summarize the main diagnostic and therapeutic tools in the management of pseudocysts and to present the main studies that compare the three different types of pseudocyst drainage.
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Affiliation(s)
- Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ioannis Passas
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Ioannis Sideris
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Demetrios Davides
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece
| | - Christos Dervenis
- Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece.,Department of Surgery, Medical School, University of Cyprus, Nicosia, Cyprus
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Consiglieri CF, Gornals JB, Busquets J, Peláez N, Secanella L, De-La-Hera M, Sanzol R, Fabregat J, Castellote J. Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:12-21. [PMID: 28882615 DOI: 10.1016/j.gastrohep.2017.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. AIMS The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). METHODS This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. RESULTS Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). CONCLUSIONS Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups.
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Affiliation(s)
- Claudia F Consiglieri
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain; Universitat Oberta de Catalunya, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
| | - Juli Busquets
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Nuria Peláez
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Lluis Secanella
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Meritxell De-La-Hera
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Resurrección Sanzol
- Anaesthesia Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - Joan Fabregat
- General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
| | - José Castellote
- Hepatology Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain
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35
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Abstract
Technological advances in the field of endoscopic ultrasound (EUS) have emerged, especially in the past decade, that have rapidly expanded the therapeutic potential of EUS, largely through the innovations of accessory technology that could not have happened without innovative changes to echoendoscopes. As interventional EUS continues to evolve, further expansion into previously uncharted areas will most certainly happen.
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Affiliation(s)
- Frank G Gress
- Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
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36
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Nabi Z, Talukdar R, Reddy DN. Endoscopic Management of Pancreatic Fluid Collections in Children. Gut Liver 2017; 11:474-480. [PMID: 28514841 PMCID: PMC5491081 DOI: 10.5009/gnl16137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 12/17/2022] Open
Abstract
The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endoprostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad,
India
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37
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Navarro S. The art of pancreatic surgery. Past, present and future. The history of pancreatic surgery. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:648.e1-648.e11. [PMID: 28533021 DOI: 10.1016/j.gastrohep.2017.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España.
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38
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Bruno MJ. Interventional endoscopic ultrasonography: Where are we headed? Dig Endosc 2017; 29:503-511. [PMID: 28181708 DOI: 10.1111/den.12842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasonography (EUS) is an essential endoscopic tool within the diagnostic and therapeutic armamentarium of gastrointestinal and hepatic diseases. EUS-guided tissue acquisition will develop towards facilitating personalized treatment by obtaining large representative tissue specimens for elaborate immunohistochemical and biomolecular typing of the tumor. Intratumoral or intravascular delivery of drugs potentially offers many advantages over systemic injection. Intratumoral application of radiofrequency ablation and photodynamic therapy show promise but need to be explored further. Appositioning and connecting luminal structures within the gastrointestinal tract using fully covered expandable lumen-apposing stents will expand its indication far beyond the drainage of (infected) fluid collections and EUS-guided gastrojejunostomy is a particularly exciting development that could have significant impact on the management of gastric outlet obstruction.
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Affiliation(s)
- Marco J Bruno
- Department of Gastroenterology & Hepatology, Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands
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39
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Venkatachalapathy S, Nayar MK. Therapeutic endoscopic ultrasound. Frontline Gastroenterol 2017; 8:119-123. [PMID: 28261439 PMCID: PMC5318651 DOI: 10.1136/flgastro-2016-100774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023] Open
Abstract
Endoscopic ultrasound (EUS) is now firmly established as one of the essential tools for diagnosis in most gastrointestinal MDTs across the UK. However, the ability to provide therapy with EUS has resulted in a significant impact on the management of the patients. These include drainage of peripancreatic collections, EUS-guided endoscopic retrograde cholangiopancreatogram, EUS-guided coeliac plexus blocks, etc. The rapid development of this area in endoscopy is a combination of newer tools and increasing expertise by endosonographers to push the boundaries of intervention with EUS. However, the indications are limited and we are at the start of the learning curve for these high-risk procedures. These therapies should, therefore, be confined to centres with a robust multidisciplinary team, including interventional endoscopists, radiologists and surgeons.
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Affiliation(s)
- Suresh Venkatachalapathy
- Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Manu K Nayar
- HPB Unit, Freeman Hospital, Newcastle Upon Tyne, UK
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Maple JT, Pannala R, Abu Dayyeh BK, Aslanian HR, Enestvedt BK, Goodman A, Komanduri S, Manfredi M, Navaneethan U, Parsi MA, Smith ZL, Thosani N, Sullivan SA, Banerjee S. Interventional EUS (with videos). Gastrointest Endosc 2017; 85:465-481. [PMID: 28117034 DOI: 10.1016/j.gie.2016.11.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 02/08/2023]
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Teoh AYB, Dhir V, Jin ZD, Kida M, Seo DW, Ho KY. Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage. GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Mumbai, India
| | - Zhen Dong Jin
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
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Tsutsui N, Suzuki Y, Saito N, Ohdaira H, Yamanouchi E, Yoshida M. Endoscopic computerized tomography guided percutaneous trans-gastric drainage: A case report on this hybrid approach. Int J Surg Case Rep 2016; 25:7-9. [PMID: 27288748 PMCID: PMC4972130 DOI: 10.1016/j.ijscr.2016.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/30/2016] [Accepted: 04/30/2016] [Indexed: 11/30/2022] Open
Abstract
Comparisons of endoscopic Computerized tomography guided percutaneous trans-gastric drainage and EUS-guided drainage reveal that endoscopic Computerized tomography guided percutaneous trans-gastric drainage is easier for surgeons to perform, takes less time, and causes less discomfort to the patient. Percutaneous transgastric drainage is more comfortable than EUS-guided drainage. The puncture can be performed safely because space is eliminated by fixation of the gastric and abdominal walls. Percutaneous drainage, percutaneous transgastric drainage, and endoscopic ultrasound (EUS)-guided transgastric drainage are primarily utilized for drainage of fluid collections dorsal to the stomach. Percutaneous transgastric drainage is performed with computed tomography (CT) guidance, but it requires inflation of a balloon in the stomach, and gastric peristalsis makes it difficult to ensure a reliable puncture route via the stomach. Using endoscopy-assisted CT-guidance, we were able to safely and effectively perform percutaneous transgastric drainage. A 69-year-old man underwent a pancreaticoduodenectomy for cancer of the inferior section of the common bile duct. Postoperative day 5, the amylase value of the drainage fluid was 1,232 IU/L, we diagnosed a pancreatic fistula developed as a result of pancreaticojejunal anastomotic failure and we performed drainage at the drain which was placed in the foramen of Winslow intraoperatively, however fluid collection dorsal to the stomach was detected on a follow-up abdominal CT scan, and the fluid was a high value of amylase, we judged the drain was not working well and the pancreatic fistula occured. Endoscopy-assisted, CT-guided percutaneous transgastric drainage was therefore performed, and the pancreatic fistula was successfully closed the fistula.
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Affiliation(s)
- Nobuhiro Tsutsui
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Nobuhiro Saito
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
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Minaga K, Kitano M, Imai H, Yamao K, Kamata K, Miyata T, Matsuda T, Omoto S, Kadosaka K, Yoshikawa T, Kudo M. Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report. World J Gastroenterol 2016; 22:5132-5136. [PMID: 27275106 PMCID: PMC4886389 DOI: 10.3748/wjg.v22.i21.5132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/24/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
We report a successful endoscopic ultrasonography-guided drainage of a huge infected multilocular walled-off necrosis (WON) that was treated by a modified single transluminal gateway transcystic multiple drainage (SGTMD) technique. After placing a wide-caliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.
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van der Wiel SE, Küttner Magalhães R, Rocha Gonçalves CR, Dinis-Ribeiro M, Bruno MJ, Koch AD. Simulator training in gastrointestinal endoscopy - From basic training to advanced endoscopic procedures. Best Pract Res Clin Gastroenterol 2016; 30:375-87. [PMID: 27345646 DOI: 10.1016/j.bpg.2016.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/14/2016] [Accepted: 04/28/2016] [Indexed: 02/06/2023]
Abstract
Simulator-based gastrointestinal endoscopy training has gained acceptance over the last decades and has been extensively studied. Several types of simulators have been validated and it has been demonstrated that the use of simulators in the early training setting accelerates the learning curve in acquiring basic skills. Current GI endoscopy simulators lack the degree of realism that would be necessary to provide training to achieve full competency or to be applicable in certification. Virtual Reality and mechanical simulators are commonly used in basic flexible endoscopy training, whereas ex vivo and in vivo models are used in training the most advanced endoscopic procedures. Validated models for the training of more routine therapeutic interventions like polypectomy, EMR, stenting and haemostasis are lacking or scarce and developments in these areas should be encouraged.
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Affiliation(s)
- S E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - R Küttner Magalhães
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Carla Rolanda Rocha Gonçalves
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Gastroenterology, Hospital Braga, Portugal.
| | - M Dinis-Ribeiro
- Department of Gastroenterology, Portugese Oncology Institute of Porto, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal; CIDES/CINTESIS, Porto Faculty of Medicine, Portugal.
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - A D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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Ekkelenkamp VE, Koch AD, de Man RA, Kuipers EJ. Training and competence assessment in GI endoscopy: a systematic review. Gut 2016; 65:607-15. [PMID: 25636697 DOI: 10.1136/gutjnl-2014-307173] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Training procedural skills in GI endoscopy once focused on threshold numbers. As threshold numbers poorly reflect individual competence, the focus gradually shifts towards a more individual approach. Tools to assess and document individual learning progress are being developed and incorporated in dedicated training curricula. However, there is a lack of consensus and training guidelines differ worldwide, which reflects uncertainties on optimal set-up of a training programme. AIMS The primary aim of this systematic review was to evaluate the currently available literature for the use of training and assessment methods in GI endoscopy. Second, we aimed to identify the role of simulator-based training as well as the value of continuous competence assessment in patient-based training. Third, we aimed to propose a structured training curriculum based on the presented evidence. METHODS A literature search was carried out in the available medical and educational literature databases. The results were systematically reviewed and studies were included using a predefined protocol with independent assessment by two reviewers and a final consensus round. RESULTS The literature search yielded 5846 studies. Ninety-four relevant studies on simulators, assessment methods, learning curves and training programmes for GI endoscopy met the inclusion criteria. Twenty-seven studies on simulator validation were included. Good validity was demonstrated for four simulators. Twenty-three studies reported on simulator training and learning curves, including 17 randomised control trials. Increased performance on a virtual reality (VR) simulator was shown in all studies. Improved performance in patient-based assessment was demonstrated in 14 studies. Four studies reported on the use of simulators for assessment of competence levels. Current simulators lack the discriminative power to determine competence levels in patient-based endoscopy. Eight out of 14 studies on colonoscopy, endoscopic retrograde cholangiopancreatography and endosonography reported on learning curves in patient-based endoscopy and proved the value of this approach for measuring performance. Ten studies explored the numbers needed to gain competence, but the proposed thresholds varied widely between them. Five out of nine studies describing the development and evaluation of assessment tools for GI endoscopy provided insight into the performance of endoscopists. Five out of seven studies proved that intense training programmes result in good performance. CONCLUSIONS The use of validated VR simulators in the early training setting accelerates the learning of practical skills. Learning curves are valuable for the continuous assessment of performance and are more relevant than threshold numbers. Future research will strengthen these conclusions by evaluating simulation-based as well as patient-based training in GI endoscopy. A complete curriculum with the assessment of competence throughout training needs to be developed for all GI endoscopy procedures.
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Affiliation(s)
| | - Arjun D Koch
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Robert A de Man
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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Dhir V, Maydeo A. EUS-guided pseudocyst drainage: Has the metal proved its mettle? Gastrointest Endosc 2015; 82:828-830. [PMID: 26472000 DOI: 10.1016/j.gie.2015.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Vinay Dhir
- Baldota Institute of Digestive Sciences, Parel, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Parel, Mumbai, India
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Nelsen EM, Johnson EA, Walker AJ, Pfau P, Gopal DV. Endoscopic ultrasound-guided pancreatic pseudocyst cystogastrostomy using a novel self-expandable metal stent with antimigration system: A case series. Endosc Ultrasound 2015; 4:229-34. [PMID: 26374582 PMCID: PMC4568636 DOI: 10.4103/2303-9027.163007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives: Development of symptomatic pseudocysts after acute pancreatitis is a common occurrence. Endoscopic ultrasound (EUS)-guided transmural drainage has become the treatment of choice for symptomatic pseudocysts. Following this procedure, stent migration can occur. A recently developed fully covered biliary metal stent with antimigration system has shown promise as an alternative endoprosthetic option for cystogastrostomy. The aim of this study is to describe the success and complications of using covered metal stents with antimigration system to drain pseudocysts at a single tertiary care center. Materials and Methods: The patients undergoing cystogastrostomy using the biliary metal stent with antimigration system over the course of a 10-month period (January-November, 2014) were retrospectively reviewed and all the pertinent information including length of the follow-up, age and sex of the patient, pseudocyst size, pseudocyst size at follow-up, and symptom improvement were recorded. Results: Five patients underwent endoscopic cystogastrostomy using a biliary metal stent with antimigration system. The average age of the patients was 57 years, with all the patients being males. The average size of the largest dimension of pseudocyst was 9 cm. The average follow-up time to repeat imaging was 30 days. All the patients had a significant improvement in their pseudocyst size, with two patients having complete resolution, one patient with a residual 2 cm cyst, and another with a residual 5 cm pseudocyst at follow-up. The average size at follow-up was 2 cm. No complications occurred during the follow-up period. No episodes of stent migration occurred. All the patients had symptom improvement at follow-up. Conclusion: Using a novel biliary covered self-expandable metal stent with antimigration system with EUS guidance to drain pseudocysts appears to be a safe and effective procedure in certain settings. Our experience shows rapid cyst resolution with no complications and no stent migration. This stent gives the providers another option when performing cystogastrostomy.
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Affiliation(s)
| | | | | | | | - Deepak V Gopal
- Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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EUS-FNA can be an effective procedure for the transesophageal drainage of a patient with intra-peritoneal abscess. Clin J Gastroenterol 2015. [PMID: 26215115 DOI: 10.1007/s12328-015-0588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is considered to be a highly beneficial and safe diagnostic tool. EUS-FNA now has a greater clinical impact because the technique is currently being applied for therapeutic as well as diagnostic purposes. The treatment of intra-peritoneal abscess after peptic ulcer perforation has traditionally been by surgery, especially when percutaneous abscess drainage is unfeasible. We report that less invasive drainage using EUS-FNA was useful in treating a patient with an abscess who had no other option but to select surgical treatment.
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49
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Pezzilli R, Zerbi A, Campra D, Capurso G, Golfieri R, Arcidiacono PG, Billi P, Butturini G, Calculli L, Cannizzaro R, Carrara S, Crippa S, De Gaudio R, De Rai P, Frulloni L, Mazza E, Mutignani M, Pagano N, Rabitti P, Balzano G. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis 2015; 47:532-543. [PMID: 25921277 DOI: 10.1016/j.dld.2015.03.022] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Abstract
This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
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50
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Puri R, Thandassery RB, Alfadda AA, Kaabi SA. Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature. World J Gastrointest Endosc 2015; 7:354-363. [PMID: 25901214 PMCID: PMC4400624 DOI: 10.4253/wjge.v7.i4.354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/25/2014] [Accepted: 01/15/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.
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