scholarly journals Benign Pancreatic Duct Strictures: Medical and Endoscopic Therapy

2000 ◽  
Vol 14 (2) ◽  
pp. 127-129
Author(s):  
JE Geenen
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Pancreatic Neoplasm ◽  
Pancreatic Disease ◽  
Therapy Options

Pancreatic duct strictures usually reflect underlying pancreatic disease and are likely caused by one or more of the following: acute or chronic pancreatitis, benign or malignant pancreatic neoplasm, pseudocyst and trauma. The characteristics of pancreatic strictures are identified, and medical and endoscopic therapy options are reviewed.

scholarly journals Motion - Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments for the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 57-59
Author(s):  
Stanley M Branch
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Clinical Problem ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Ducts ◽  
Success Rates ◽  
Long Term Follow Up

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

scholarly journals Motion – Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments Against the Motion

2003 ◽  
Vol 17 (1) ◽  
pp. 61-63 ◽  
Author(s):  
Darwin L Conwell
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Major Complication ◽  
Difficult Problem ◽  
Pancreatic Pseudocysts ◽  
Success Rates ◽  
Endoscopic Techniques ◽  
Large Numbers ◽  
Pancreatic Disorders

Endoscopic therapy can be used to dilate strictures in the pancreatic duct, remove stones and drain pseudocysts. In addition, it provides an alternative to surgery for the management of pain in patients with chronic pancreatitis. Pain is a difficult problem in these patients, especially if substance abuse is present, and its medical management is generally unsatisfactory. The concept that pancreatic pain is related to increased pressure in the main pancreatic duct is unproven, and is not supported by the results of surgical intervention. Although pancreatic stenting is often technically successful at achieving drainage of the pancreatic duct and relieving pain over the short term, pain usually recurs with time, complications are frequent, and repeated stent changes are usually necessary. Pancreatic pseudocysts can be drained endoscopically, using transpapillary, cystogastrostomy or cystoduodenostomy approaches, but success rates are less than 50% and bleeding is a major complication. Pseudocysts should not be drained unless they are symptomatic, causing complications or enlarging. There have been no published studies comparing endoscopic with surgical or radiological modalities. Endoscopic therapy of pancreatic disorders is a new and interesting technique, but initial promising results need to be confirmed in large, well-designed clinical trials. Such studies would need to enrol large numbers of patients, and involve measurement of technical success, pain severity and quality of life parameters. At present, endoscopic techniques must be considered experimental.

scholarly journals The Role of Endoscopic and Surgical Treatment in Chronic Pancreatitis

2020 ◽  
Vol 109 (1) ◽  
pp. 69-78 ◽  
Author(s):  
M. Udd ◽  
L. Kylänpää ◽  
A. Kokkola
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Hospital Admissions ◽  
Endoscopic Therapy ◽  
Treatment Options ◽  
Biliary Duct ◽  
Heavy Alcohol Consumption ◽  
Pancreatic Duct Stone

Chronic pancreatitis is a long-term illness leading to hospital admissions and readmission. This disease is often caused by heavy alcohol consumption and smoking. Patients with chronic pancreatitis suffer from acute or chronic pain episodes, recurrent pancreatitis, and complications, such as pseudocysts, biliary duct strictures, and pancreatic duct fistulas. Pancreatic duct strictures and stones may increase intraductal pressure and cause pain. Endoscopic therapy is aiming at decompressing the pressure and relieving the pain, most commonly with pancreatic duct stents and pancreatic duct stone retrieval. Early surgery is another option to treat the pain. In addition, endotherapy has been successful in treating complications related to chronic pancreatitis. The therapy should be individually chosen in a multidisciplinary meeting. Endoscopic therapy and surgery as treatment options for chronic pancreatitis are discussed in this review.

scholarly journals Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

Endoscopy ◽  
2019 ◽  
Vol 51 (02) ◽  
pp. 179-193 ◽  
Author(s):  
Jean-Marc Dumonceau ◽  
Myriam Delhaye ◽  
Andrea Tringali ◽  
Marianna Arvanitakis ◽  
Andres Sanchez-Yague ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Therapy ◽  
Plastic Stents ◽  
Spontaneous Clearance ◽  
Pancreatic Stones ◽  
Moderate Quality ◽  
Short Disease Duration ◽  
Quality Evidence

Main RecommendationsESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

Percutaneous Pancreatography under Ultrasonographic Guidance

1996 ◽  
Vol 37 (1P1) ◽  
pp. 75-78 ◽  
Author(s):  
M. Opačić ◽  
N. Rustemović ◽  
R. Pulanić ◽  
B. Vucelić ◽  
M. Frković ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Carcinoma ◽  
Pancreatic Duct ◽  
Good Alternative ◽  
Pancreatic Disease ◽  
Contrast Injection ◽  
Alternative Method ◽  
Fluoroscopic Control ◽  
Ultrasonographic Guidance

Purpose: The aim of the study was to evaluate percutaneous pancreatography as an alternative method for pancreatic duct visualisation in patients with pancreatic disease. Material and Methods: In 21 patients with pancreatic disease and previously unsuccessful ERCP, puncture of the pancreatic duct was carried out under ultrasonographic guidance with an 0.7-mm Chiba needle, and contrast injection was made under fluoroscopic control in the pancreatic duct. Results: The procedure was successful in 18 patients (86%). In 10 patients, chronic pancreatitis was found, and in 8 patients, pancreatic carcinoma. Conclusion: Percutaneous pancreatography is a good alternative method for visualisation of the pancreatic duct in patients with pancreatic disease and previously unsuccessful ERCP.

scholarly journals Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

2021 ◽  
Author(s):  
Ayah Megahed ◽  
Rahul Hegde ◽  
Pranav Sharma ◽  
Rahmat Ali ◽  
Anas Bamashmos
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pleural Fluid ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Pleural Effusions ◽  
Diagnostic Challenge ◽  
Abdominal Symptoms ◽  
Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

Endoscopic therapy of chronic pancreatitis

2000 ◽  
Vol 52 (6) ◽  
pp. 843-848 ◽  
Author(s):  
Glenn M. Eisen ◽  
Robynne Chutkan ◽  
Jay L. Goldstein ◽  
Bret T. Petersen ◽  
Michael E. Ryan ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Therapy
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