Pancreaticopleural fistulas are a rare complication of pancreatitis. We report two cases from our institution and review 37 cases of pancreaticopleural fistulas identified in the literature. Endoscopic retrograde chol...Pancreaticopleural fistulas are a rare complication of pancreatitis. We report two cases from our institution and review 37 cases of pancreaticopleural fistulas identified in the literature. Endoscopic retrograde cholangiopancreatography was more sensitive compared to computed tomography in demonstrating pancreaticopleural fistulas (79%versus 43%, respectively). Medical therapy with total parenteral nutrition, octreotide, and/or chest tube placement was successful in resolving the pancreaticopleural fistula in up to 33%of cases. None of the patients who underwent pancreatic duct stent and/or nasopancreatic drain placement required surgical intervention. Endoscopic retrograde cholangiopancreatography is the initial test of choice when the diagnosis of pancreaticopleural fistula is suspected. Early endoscopic intervention with pancreatic duct stent placement is recommended given its high success rate in fistula closure. Medical therapies are useful adjuncts to endoscopic therapy, but rarely result in pancreaticopleural fistula closure alone. Surgical interventions should only be considered after failure of endoscopic and medical therapies.展开更多
Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a g...Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance.Design:Retrospective chart review.Setting:Academic medical center.Patients:Consecutive subjects from December 1,2002,to January 10,2005,with symptomatic pseudocysts in whom EUS-guided drainage was attempted.Interventions:By using a therapeutic linear echoendoscope,a 19-gauge aspiration needle was inserted into the pseudocyst.A guidewire was placed through the needle,and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa.The needle knife was then advanced by using electrocautery into the pseudocyst.The cystenterostomy was dilated by using a balloon over the guidewire.One to 4 stents were placed through the tract.Main Outcome Measurements:Successful pseudocyst drainage.Results:A total of 21 of 23 patients underwent technically successful pseudocyst drainage.One patient had self-limited hypotension during the procedure.Another patient had free intraperitoneal air after the procedure but correct stent placement.Limitations:Retrospective analysis,small sample size.Conclusions:In this preliminary experience,wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.展开更多
文摘Pancreaticopleural fistulas are a rare complication of pancreatitis. We report two cases from our institution and review 37 cases of pancreaticopleural fistulas identified in the literature. Endoscopic retrograde cholangiopancreatography was more sensitive compared to computed tomography in demonstrating pancreaticopleural fistulas (79%versus 43%, respectively). Medical therapy with total parenteral nutrition, octreotide, and/or chest tube placement was successful in resolving the pancreaticopleural fistula in up to 33%of cases. None of the patients who underwent pancreatic duct stent and/or nasopancreatic drain placement required surgical intervention. Endoscopic retrograde cholangiopancreatography is the initial test of choice when the diagnosis of pancreaticopleural fistula is suspected. Early endoscopic intervention with pancreatic duct stent placement is recommended given its high success rate in fistula closure. Medical therapies are useful adjuncts to endoscopic therapy, but rarely result in pancreaticopleural fistula closure alone. Surgical interventions should only be considered after failure of endoscopic and medical therapies.
文摘Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance.Design:Retrospective chart review.Setting:Academic medical center.Patients:Consecutive subjects from December 1,2002,to January 10,2005,with symptomatic pseudocysts in whom EUS-guided drainage was attempted.Interventions:By using a therapeutic linear echoendoscope,a 19-gauge aspiration needle was inserted into the pseudocyst.A guidewire was placed through the needle,and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa.The needle knife was then advanced by using electrocautery into the pseudocyst.The cystenterostomy was dilated by using a balloon over the guidewire.One to 4 stents were placed through the tract.Main Outcome Measurements:Successful pseudocyst drainage.Results:A total of 21 of 23 patients underwent technically successful pseudocyst drainage.One patient had self-limited hypotension during the procedure.Another patient had free intraperitoneal air after the procedure but correct stent placement.Limitations:Retrospective analysis,small sample size.Conclusions:In this preliminary experience,wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.
