Xu N, Li LS, Yue WY, Zhao DQ, Xiang JY, Zhang B, Wang PJ, Cheng YX, Linghu EQ, Chai NL. Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports. World J Gastrointest Surg 2022; 14(8): 855-861 [PMID: 36157367 DOI: 10.4240/wjgs.v14.i8.855]
Corresponding Author of This Article
Ning-Li Chai, MD, PhD, Chief Doctor, Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2022; 14(8): 855-861 Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.855
Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports
Ning Xu, Long-Song Li, Wen-Yi Yue, Dan-Qi Zhao, Jing-Yuan Xiang, Bo Zhang, Peng-Ju Wang, Ya-Xuan Cheng, En-Qiang Linghu, Ning-Li Chai
Ning Xu, Long-Song Li, Dan-Qi Zhao, Jing-Yuan Xiang, Bo Zhang, Peng-Ju Wang, Ya-Xuan Cheng, En-Qiang Linghu, Ning-Li Chai, Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
Wen-Yi Yue, Department of Radiology, Chinese PLA General Medical School, Beijing 100853, China
Author contributions: Xu N and Li LS contributed equally to this manuscript; Chai NL and Xu N contributed to manuscript drafting; Xu N and Yue WY wrote the manuscript; Li LS, Zhao DQ, Xiang JY, Zhang B, Wang PJ and Cheng YX were responsible for the revision of the manuscript for significant content; Chai NL and Linghu EQ were the patient’s endoscopists and reviewed the literature; all authors issued final approval for the version to be submitted.
Supported byNational Natural Science Foundation of China, No. 82070682; and Beijing Municipal Science and Technology Commission, China, No. Z181100001718177.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: There are no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning-Li Chai, MD, PhD, Chief Doctor, Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Received: May 26, 2022 Peer-review started: May 26, 2022 First decision: June 19, 2022 Revised: June 27, 2022 Accepted: August 6, 2022 Article in press: August 6, 2022 Published online: August 27, 2022
Abstract
BACKGROUND
Endoscopic ultrasound (EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections (PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.
CASE SUMMARY
Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography (CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.
CONCLUSION
Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.
Core Tip: Endoscopic ultrasound-guided drainage has previously proved to be an excellent method to cure pancreatic fluid collections (PFCs). However, it is not recommended for PFCs with the gastric varices and the abundant surrounding vessels because of the high bleeding risk. Preoperative interventional embolization decreases the possibility of hemorrhage when a transluminal tunnel is established between the stomach and cyst. In our cases, the patients underwent this new preoperative arrangement and transgastric drainage was performed. No bleeding or other intraoperative complications occurred. We recommend this modality as a new strategy for PFCs drainage in patients with high bleeding risk.
