Clinical Endoscopy

Systematic Review and Meta-analysis

Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis: Jad AbiMansour, Veeravich Jaruvongvanich, Saran Velaga, Ryan Law, Andrew C. Storm, Mark Topazian, Michael J. Levy, Ryan Alexander, Eric J. Vargas, Aliana Bofill-Garica, John A. Martin, Bret T. Petersen, Barham K. Abu Dayyeh, Vinay Chandrasekhara; Clin Endosc 2024;57(5):595-603. Published online July 24, 2024; DOI: https://doi.org/10.5946/ce.2023.297

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs.
Methods
A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs).
Results
Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480).
Conclusions
Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.

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Original Article

Increasing trend of endoscopic drainage utilization for the management of pancreatic pseudocyst: insights from a nationwide database: Khaled Elfert, Salomon Chamay, Lamin Dos Santos, Mouhand Mohamed, Azizullah Beran, Fouad Jaber, Hazem Abosheaishaa, Suresh Nayudu, Sammy Ho; Clin Endosc 2024;57(1):105-111. Published online August 4, 2023; DOI: https://doi.org/10.5946/ce.2023.054

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed.
Methods
The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes.
Results
Endoscopic drainage was the most commonly used drainage modality in 2018–2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001).
Conclusions
Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.

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Pancreatic pseudocyst: The past, the present, and the future
Jonathan GA Koo, Matthias Yi Quan Liau, Igor A Kryvoruchko, Tamer AAM Habeeb, Christopher Chia, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2024; 16(7): 1986. CrossRef

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Case Report

Successful Endoscopic Ultrasound-Guided Treatment of a Spontaneous Rupture of a Hemorrhagic Pancreatic Pseudocyst: Chan Park, Tae Hyeon Kim, Hyung Ku Chon; Clin Endosc 2021;54(5):763-766. Published online March 3, 2021; DOI: https://doi.org/10.5946/ce.2020.279

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Spontaneous rupture of a hemorrhagic pancreatic pseudocyst may be life-threatening. Endoscopic ultrasound (EUS)-guided drainage has been reported to be a valuable treatment option for pancreatic pseudocysts. However, its usefulness in the management of a ruptured pancreatic pseudocyst is limited. We report a rare case of a spontaneous rupture of a hemorrhagic pancreatic pseudocyst in a patient with chronic pancreatitis, which was successfully treated with EUS-guided gastrocystostomy with a fully covered self-expandable metallic stent.

Citations

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Perforation of pancreatic pseudocyst diagnosed with endoscopy and treated with percutaneous drainage
Mako Koseki, Yusuke Hashimoto
DEN Open.2024;[Epub] CrossRef
Spontaneous rupture of an infected pseudocyst of the pancreas: A case report
Mohamed Fadhel Chtourou, Hazem Beji, Slim Zribi, Yassine Kallel, Mahdi Bouassida, Hassen Touinsi
International Journal of Surgery Case Reports.2023; 105: 107987. CrossRef
A ruptured pancreatic pseudocyst causes acute peritonitis with clinical characteristics of a gastrointestinal tract perforation
Tran Que Son, Tran Hieu Hoc, Tran Thu Huong, Ngo Quang Dinh, Pham Van Tuyen
Journal of Surgical Case Reports.2022;[Epub] CrossRef

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Original Articles

Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm: Ming Ming Xu, Iman Andalib, Aleksey Novikov, Enad Dawod, Moamen Gabr, Monica Gaidhane, Amy Tyberg, Michel Kahaleh; Clin Endosc 2020;53(3):355-360. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2019.113

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Background
/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.
Methods
Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.
Results
A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).
Conclusions
A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.

Citations

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Novel classification system for walled-off necrosis: a step toward standardized nomenclature and risk-stratification framework
Serge Baroud, Vinay Chandrasekhara, Andrew C. Storm, Ryan J. Law, Eric J. Vargas, Michael J. Levy, Tala Mahmoud, Fateh Bazerbachi, Aliana Bofill-Garcia, Rabih Ghazi, Daniel B. Maselli, John A. Martin, Santhi Swaroop Vege, Naoki Takahashi, Bret T. Petersen
Gastrointestinal Endoscopy.2023; 97(2): 300. CrossRef
Endoscopic versus percutaneous drainage for pancreatic fluid collection after pancreatic surgery: An up-to-date meta-analysis and systematic review
Liang Chen, Ting Li, Bin Wang, Yunxiao Cheng, Sicong Zhao, Yunxiao Lyu
Asian Journal of Surgery.2022; 45(8): 1519. CrossRef
Transluminal and retroperitoneal minimally invasive necrosectomy in acute pancreatitis
A. V. Fedorov, V. N. Ektov, M. A. Khodorkovskiy
Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2022; 27(3): 81. CrossRef
Endoscopic transluminal interventions in the treatment of acute necrotizing pancreatitis
A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (9): 85. CrossRef
Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis
Rajat Garg, Shradha Gupta, Amandeep Singh, Marian T. Simonson, Tarun Rustagi, Prabhleen Chahal
Pancreatology.2021; 21(8): 1540. CrossRef
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Robert Dorrell, Swati Pawa, Yi Zhou, Neeraj Lalwani, Rishi Pawa
Diagnostics.2020; 10(5): 337. CrossRef
Importance of Pancreatic Duct Stenting and Enteral Feeding in Treatment Algorithm of Pancreatic Fluid Collections
Seong-Hun Kim, Eun Ji Shin
Clinical Endoscopy.2020; 53(3): 253. CrossRef
Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification
Igor Mendonça Proença, Marcos Eduardo Lera dos Santos, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sergio Eiji Matuguma, Spencer Cheng, Thomas R McCarty, Epifanio Silvino do Monte Junior, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura
World Journal of Gastroenterology.2020; 26(45): 7104. CrossRef

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Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting: Rajat Garg, Abdelkader Chaar, Susan Szpunar, Babu P. Mohan, Mohammed Barawi; Clin Endosc 2020;53(4):480-486. Published online October 16, 2019; DOI: https://doi.org/10.5946/ce.2019.116

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Background
/Aims: Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.
Methods
We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events.
Results
Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal.
Conclusions
Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

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EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef
Trans-cavity lumen-apposing metal stent removal: an alternative safe modality
Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
Clinical Endoscopy.2023; 56(1): 129. CrossRef
Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management
Elia Armellini, Flavio Metelli, Andrea Anderloni, Anna Cominardi, Giovanni Aragona, Michele Marini, Fabio Pace
World Journal of Gastroenterology.2023; 29(21): 3341. CrossRef
Lumen-apposing metal stents: How far are we from standardization? An Italian survey
Carlo Fabbri, Chiara Coluccio, Cecilia Binda, Alessandro Fugazza, Andrea Anderloni, Ilaria Tarantino, NA i-EUS Group
Endoscopic Ultrasound.2022; 11(1): 59. CrossRef
Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature
Hussam I. A. Alzeerelhouseini, Muawiyah Elqadi, Mohammad N. Elqadi, Sadi A. Abukhalaf, Hazem A. Ashhab, Yoshifumi Nakayama
Case Reports in Gastrointestinal Medicine.2021; 2021: 1. CrossRef
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Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
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Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis
Jing Li, Qian Zhang, Anni Zhou, Guiping Zhao, Peng Li
Chronic Diseases and Translational Medicine.2021; 7(3): 157. CrossRef
Reply
Kazuki Takeishi, Toru Ikegami, Tomoharu Yoshizumi, Nao Fujimori, Masaki Mori
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Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis
Vinay Chandrasekhara, Marc Barthet, Jacques Devière, Fateh Bazerbachi, Sundeep Lakhtakia, Jeffrey J. Easler, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Margaret L. Gourlay, Barham K. Abu Dayyeh
Endoscopy International Open.2020; 08(11): E1639. CrossRef

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Comparison of Clinical Outcomes between Plastic Stent and Novel Lumen-apposing Metal Stent for Endoscopic Ultrasound-Guided Drainage of Peripancreatic Fluid Collections: Ho Cheol Shin, Chang Min Cho, Min Kyu Jung, Seong Jae Yeo; Clin Endosc 2019;52(4):353-359. Published online March 13, 2019; DOI: https://doi.org/10.5946/ce.2018.154

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound (EUS)-guided transmural drainage for peripancreatic fluid collections (PFCs) has gained wide acceptance as a nonsurgical intervention. Although a lumen-apposing metal stent (LAMS) was recently introduced, there are few data comparing the clinical outcomes between LAMS and plastic stent (PS) drainage.
Methods
Endoscopy databases of all patients who had undergone EUS-guided drainage for PFCs were searched and the clinical outcomes of EUS-guided drainage according to stent-type used were compared.
Results
A total of 27 patients (median age, 56 years) with PFCs underwent EUS-guided transmural drainage between January 2011 and December 2017. Of these, 17 underwent PS placement and 10 underwent LAMS placement. There was no significant difference in the technical success rate between the 2 groups (94.1% vs. 100%, p=1.0). Procedure time was shorter in the LAMS group compared to that in the PS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Among subjects with clinical success, recurrence of PFC after stent removal occurred in 5 of 12 patients with PS and 4 of 10 with LAMS, without statistical difference (41.7% vs. 40.0%, p=1.0).
Conclusions
Although our study showed similar clinical outcomes for LAMS and PS, further prospective trials are required to validate the superiority of LAMS.

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Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis
Fadi Hawa, Jean M. Chalhoub, Ana Vilela, Elit Quingalahua, Carol Shannon, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman, Matthew J. DiMagno, Jorge D. Machicado
Surgical Endoscopy.2024; 38(5): 2350. CrossRef
Multicenter study of the efficacy and safety of electrocautery-enhanced lumen-apposing metal stents for the internal drainage of pancreatic fluid collections
Chen-Shuan Chung, Yu-Ting Kuo, Yi-Chun Chiu, Yang-Chao Lin, Chi-Ying Yang, Kuan-Chih Chen, Szu-Chia Liao, Cheuk-Kay Sun, Yen-Chih Lin, Hsiu-Po Wang
Scientific Reports.2024;[Epub] CrossRef
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Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
Endoscopic ultrasound-guided pancreatic fluid collection drainage: Where are we?
Anupam Kumar Singh, Manish Manrai, Rakesh Kochhar
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Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis
Edson Guzmán‐Calderón, Alfonso Chacaltana, Ramiro Díaz, Bruno Li, Belen Martinez‐Moreno, José Ramón Aparicio
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Yunxiao Lyu, Ting Li, Bin Wang, Yunxiao Cheng, Liang Chen, Sicong Zhao
Pancreas.2021; 50(4): 571. CrossRef
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Nian-Jun Xiao, Ting-Ting Cui, Fang Liu, Wen Li
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Current treatment of pancreatic pseudocysts: a systematic review
V. M. Durleshter, S. R. Genrikh, A. V. Makarenko, D. S. Kirakosyan
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There Is No Advantage to Transpapillary Pancreatic Duct Stenting for the Transmural Endoscopic Drainage of Pancreatic Fluid Collections: A Meta-Analysis: Sunil Amin, Dennis J. Yang, Aimee L. Lucas, Susana Gonzalez, Christopher J. DiMaio; Clin Endosc 2017;50(4):388-394. Published online April 17, 2017; DOI: https://doi.org/10.5946/ce.2016.091

Abstract PDF PubReader ePub

Background
/Aims: Options for the endoscopic management of symptomatic pancreatic fluid collections (PFCs) include transmural drainage (TM) alone, transpapillary drainage (TP) alone, or a combination of both drainage method (CD). There have been conflicting reports about the best method. This study performed a meta-analysis to determine whether CD presents an added clinical benefit over TM.
Methods
The included studies compared TM with CD and reported clinical success for both methods. A random-effects model was used to determine the pooled odds ratios (ORs) and the 95% confidence intervals (CIs) for the following outcomes: technical success, clinical success, complications, and recurrence.
Results
Nine studies involving a combined total of 604 drainage procedures—373 TMs (62%) and 231 CDs (38%)—were included. CD showed no additional benefit over TM in terms of technical success (OR, 1.12; 95% CI, 0.37–3.37; p=0.85), clinical success (OR, 1.11; 95% CI, 0.65–1.89; p=0.70), recurrence (OR, 1.49; 95% CI, 0.53–4.21; p=0.45), or complications (OR, 1.15; 95% CI, 0.61–2.18; p=0.67).
Conclusions
Pancreatic duct (PD) stenting provides no additional clinical benefit for the TM of PFCs (particularly pseudocysts). Patients undergoing the TM of symptomatic pseudocysts may not require endoscopic retrograde pancreatography (ERP).

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Endoscopic management of pancreatic collections. Endoscopic Ultrasound Group from the Spanish Society of Digestive Endoscopy (GSEED-USE) Clinical Guidelines
Mariano González-Haba Ruiz, María Teresa Betés Ibáñez, Belén Martínez Moreno , Alejandro Repiso Ortega, Carlos de la Serna Higuera, Julio Iglesias García, Oriol Sendino García, María Moris Felgueroso, Belén Agudo Castillo, José Miguel Esteban Lóp
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
Pancreatic pseudocyst: The past, the present, and the future
Jonathan GA Koo, Matthias Yi Quan Liau, Igor A Kryvoruchko, Tamer AAM Habeeb, Christopher Chia, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2024; 16(7): 1986. CrossRef
A release from WONderland: endoscopic ultrasonography-guided reconnection of disconnected pancreatic ducts across a walled-off necrosis cavity
Tatsuya Sato, Tomotaka Saito, Tsuyoshi Hamada, Yousuke Nakai, Mitsuhiro Fujishiro
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E. Y. Sadovnikova, A. E. Klimov, V. A. Ivanov, M. Y. Persov, D. T. Nazarov
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Marcus Hollenbach, Jürgen Feisthammel, Albrecht Hoffmeister
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Focused Review Series: Endoscopic Intervention in Pancreatitis

Endoscopic Drainage of Pseudocysts: Tae Jun Song, Sang Soo Lee; Clin Endosc 2014;47(3):222-226. Published online May 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.3.222

Abstract PDF PubReader ePub

During the last decade, great progress has been made in minimally invasive endoscopic techniques. For pancreatic pseudocysts (PPCs), endoscopic drainage has become the first-line therapeutic option. Recent advances in therapeutic endoscopic ultrasound (EUS)-related techniques have focused on EUS-guided transmural drainage, which is now replacing the conventional endoscopy-guided transmural drainage. While transmural drainage is usually performed using multiple plastic stents with or without a nasocystic drain, fully covered self-expandable metal stents are now being used with increasing frequency. In this review, we discuss some of the controversies related to the endoscopic drainage of PPCs.

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Special Issue Articles of IDEN 2013

Pancreatic Fluid Collection Drainage by Endoscopic Ultrasound: An Update: Shashideep Singhal, Stephen R. Rotman, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(5):506-514. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.506

Abstract PDF PubReader ePub

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

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Metal versus Plastic Stent for Transmural Drainage of Pancreatic Fluid Collections: Ji Young Bang, Shyam Varadarajulu; Clin Endosc 2013;46(5):500-502. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.500

Abstract PDF PubReader ePub

The conventional management of pancreatic fluid collections (PFCs) involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and oftentimes the need for other adjunctive treatment measures. Therefore, the use of endoscopy to drain PFCs is becoming increasingly popular. Randomized trials have demonstrated that endoscopic ultrasound-guided drainage is superior to conventional endoscopy in terms of technical success and potentially decreases the rates of procedural complications. While transmural drainage is usually undertaken by deployment of plastic endoprosthesis, of late, fully covered self-expandable metal stents are being placed with increasing frequency. However, the benefits of this approach are unclear and require further validation in prospective trials.

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A novel self-expanding biflanged metal stent vs tubular metal stent for EUS-guided transmural drainage of pancreatic pseudocyst
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Case Report

Pancreatic Pseudocyst after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Mass: Kwang Hyun Chung, Ji Kon Ryu, Hong Sang Oh, Ji Yeon Seo, Eunhyo Jin, Dong Hyeon Lee, Yong-Tae Kim, Yong Bum Yoon; Clin Endosc 2012;45(4):431-434. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.431

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is well known as a safe diagnostic procedure. We report the first case of pancreatic pseudocyst after EUS-FNA of the pancreatic body mass. A 60-year-old male underwent EUS-FNA for incidentally detected pancreatic solid mass which was suspected as neuroendocrine tumor. Two weeks later, the patient visited emergency room with acute abdominal pain and right upper quadrant tenderness; leukocytosis and elevated C-reactive protein, amylase, and lipase levels were noted. Computed tomography discovered newly developed 11.5×9.5 cm sized cystic mass communicating with the main pancreatic duct. Cyst fluid analysis revealed amylase level of 3,423 U/L and fluid culture isolated Streptococcus parasanguinis. The cystic mass corresponds with pancreatic pseudocyst. FNA induced main pancreatic duct injury and fluid leakage may cause it. Endoscopists who perform EUS-FNA must remember that pancreatic main duct injury can occur as one of severe complications and that it could be treated successfully with endoscopic internal drainage.

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7,134 View
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7 Crossref

Linear Array Endoscopic Ultrasound-Guided Drainage of a Pancreatic Pseudocyst without Using Fluoroscopy: Kwi-Sook Choi, M.D., Sang Soo Lee, M.D., Sung Hee Pyo, M.D., Ja Young Kim, M.D., Jong Cheol Kim, M.D., Eun Kwang Choi, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.; Korean J Gastrointest Endosc 2006;32(4):302-305. Published online April 30, 2006

Abstract PDF: Endoscopic drainage of pancreatic pseudocysts is the initial treatment of choice for symptomatic pancreatic pseudocysts and nonresolving pseudocysts. Recently, endoscopic ultrasound (EUS) has been used as a guide for transmural entry and the safer drainage of pancreatic pseudocysts. We report a case of therapeutic linear array EUS- guided pseudocyst drainage without the use of fluoroscopy in a patient with portal hypertension. (Korean J Gastrointest Endosc 2006;32:302⁣306)

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Upper Gastrointestinal Hemorrhage from Pancreatic Pseudocyst Involving the Duodenum: A Case Report: Chan Ran You, M.D., Seung Whan Shin, M.D., Bo In Lee, M.D., Jeong Seon Ji, M.D., Byung Wook Kim, M.D., Hwang Choi, M.D., Se Hyun Cho, M.D., Hiun Suk Chae, M.D., Kyu Yong Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2004;29(4):217-221. Published online October 30, 2004

Abstract PDF: Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocysts are infection, rupture, fistula, obstruction and hemorrhage. However, an upper gastrointestinal bleeding caused by pancreatic pseudocyst is rare. Pseudocysts with complication like hemorrhage require percutaneous, endoscopic or surgical treatment. We report a case of the pancreatic pseudocyst involving duodenal wall with upper gastrointestinal hemorrhage, which was improved by conservative treatment. (Korean J Gastrointest Endosc 2004;29: 217⁣221)

1,860 View
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췌장 가성낭에 대한 내시경적 낭종배액술: Korean J Gastrointest Endosc 2003;27(5):420-420. Published online November 20, 2003

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내시경적 낭종 배액술로 치료한 췌장 가성낭종 1 예: Korean J Gastrointest Endosc 2001;23(5):424-424. Published online November 30, 2000

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지상발표 / 위 : 급성 췌장염에 합병된 위내 가성 낭종: Korean J Gastrointest Endosc 2001;22(5):391-391. Published online November 30, 2000

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구연 / 담췌 : 67 세 남자 , 심와부 동통: Korean J Gastrointest Endosc 2001;22(5):329-330. Published online November 30, 2000

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위벽에 종양으로 발현한 췌장 가성 낭종 1 예 ( A Gastric Intramural Pancreatic Pseudocyst : An Unuaual Presentation as a Gastric Intramural Tumor ): Korean J Gastrointest Endosc 2001;23(4):269-272. Published online November 30, 2000

Abstract PDF: We report a case of pancreatic pseudocyst presenting as an intramural gastric tumor on upper gastrointestinal examination, endoscopic ultrasound and computed tomography of the abdomen. Pancreatic pseudocysts in the stomach wall is rare and the most of them presented as a cystic mass, but this case was presented as a gastric mural solid tumor. Exploration revealed an about 4´4´2 cm sized round mass at the midbody of great curvature of stomach, it was in the muscle layer, and removed by surgical operation. The correct diagnosis of this case was established postoperately on the pathologic examination revealed pancreatic pseudocyst. (Korean J Gastrointest Endosc 2001;23:269-272)

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십이지장벽 내에 발생한 췌장 가성낭종 1예 ( A Case of Intramural Pancreatic Pseudocyst of the Duodenum ): Korean J Gastrointest Endosc 2000;20(1):58-62. Published online November 30, 1999

Abstract PDF: Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum. (Korean J Gastrointest Endosc 2000;20:58 62)

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췌장 가성낭종 내에 완전 삽입된 Pigtail 스텐트의 올가미를 이용한 교정 (Correction of Incidentally Migrated Pigtail Stent in Pancreatic Pseudocyst using Polypectomy Snare): Korean J Gastrointest Endosc 1999;19(2):318-321. Published online November 30, 1998

Abstract PDF: Endoscopic drainage of pancreatic pseudocysts is a new nonsurgical treatment modality. Among the cystogastrostomy and stent related complications, proximal migration of stent is rare and the correction of inserted stent into a pseudocyst is very difficult. We report a correction of an incidentally inserted pigtail stent into pseudocyst using a polypectomy snare. (Korean J Gastrointest Endosc 19: 318 ∼321, 1999)

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증례 : 식도 위장관 ; 내시경적 낭종배액술로 치료한 췌장 가성낭종 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of Pancreatic Pseudocyst Treated with Endoscopic Cystogastrostomy throughout Stent and ENPD Catheter ): Korean J Gastrointest Endosc 1998;18(6):951-956. Published online November 30, 1997

Abstract PDF: Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter. (Korean J Gastrointest Endosc 18: 951-956, 1998)

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증례 : 식도 위장관 ; 성인에서 발견된 췌장 가성낭종 양상을 보인 위 거대 중복낭종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Large Gastric Duplication Cyst Resembling a Pancreatic Pseudocyst in an Adulf - Report of one case - ): Korean J Gastrointest Endosc 1998;18(5):719-725. Published online November 30, 1997

Abstract PDF: Duplication of the alimentary tract is an unusual congenital anomaly which may occur at any level, from the oral cavity to the rectum. Gastric duplication cyst is quite rare and most of them are presented in infancy with the sypmtoms of vomiting, abdominal pain, weight loss, gastrointestinal bleeding resulting from partial or complete obstruction. Some cases have not been diagnosed until adult when duplication cyst is not large enough to cause acute obstruction in infancy. Our case is more unusual in the aspect of its presence in adult and its nature resembles huge pancreatic pseudocyst. A 18-year man came to our hospital with complaint of epigastric pain for three days. A gastrofiberoscopy revealed a round protruding mass with smooth surface of normal mucosa at the fundus and computed tomography of the abdomen revealed the presence of 6.0 X 6.0 cm sized cystic mass between posterior wall of stomach and pancreas, and another 2.0 x 2.0 cm sized mass in ant. wall of stomach, which were regarded as mutiple pancreatic pseudocysts in perigastric region. Endoscopic retrograde cholangiopancreatography did not disclose any pancreatic ductal abnormality or communication with the cyst. Endoscopic ultrasonography showed anechoic cystic mass under 3rd layer of stomach wall, which was removed by surgical resection. Postoperative pathologic examination disclosed multiple gastric duplications. (Korean J Gastrointest Endosc 18: 719-723, 1998)

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증례 : 담도 췌장 ; 만성췌장염에 동반된 가성동맥류 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of a Pseudoaneurysm in Chronic Pancreatitis ): Korean J Gastrointest Endosc 1998;18(2):276-280. Published online November 30, 1997

Abstract PDF: The bleeding pseudoaneurysm is a rare condition but one of the lethal complications in patients with chronic pancreatitis. Early diagnosis and emergent intervention can reduce mortality and promise better outcomes. We experienced a case of a bleeding pseudo- aneurysm in a chronic pancreatitis patient. The 44-year-old male was suffering from con- tinuous, vague epigastric pain and black tarry stool. An abdominal CT scan revealed a homogeneously enhancing round mass in the pancreatic pseudocyst, and celiac angi- ography found that a pseudoaneurysm had originated from the pancreaticoduodenal artery. The patient was treated with Whipple's operation and was later discharged, having improved in his condition. (Korean J Gastrointesl Endosc 18: 276-280, 1998)

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증례 : 담도 췌장 ; 상부위장관 출혈로 나타난 출혈성 췌장가성낭종 ( Case Reports : Biliary Tract & Pancreas ; Pancreatic Pseudocyst Causing Gastrointestinal Hemorrhage ( Hemosuccus pancreaticus ) ): Korean J Gastrointest Endosc 1995;15(4):803-809. Published online November 30, 1994

Abstract PDF: Hemorrhage into a pancreatic pseudocyst is a rare, but increasingly recognized as a cause of massive gastrointestial bleeding. Bleeding pseudocysts may rupture into the stomach, duodenum, common bile duct, and splenic vein, or can be decompressed via the duct of Wirsung. Also it will result in upper gastrointestinal bleeding. This represents a life-threatening and frequently unrecognized complication of pancreatic disease. Proper diagnostic workup and prompt surgical management afford the patient the best chance for survival . We report a patient with pseudocyst bleeding into the gastrointestinal tract via the duct of Wirsung and discuss the current diagnostic and therapeutic approach. (Kor J Gastrointest Endosc 15: 803-807, 1995)

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