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Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy

A 76-years-old man who underwent pylorus-preserving pancreaticoduodenectomy for lower cholangiocarcinoma developed peritonitis with intra-abdominal abscess from anastomotic leakage. We have done a reoperation for surgical drainage and jejunostomy for intestinal decompression. After operation, pancre...

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Autores principales: Iwasaki, Eisuke, Itoi, Takao, Minami, Kazuhiro, Kitago, Minoru, Hibi, Taizo, Kanai, Takanori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569854/
http://dx.doi.org/10.4103/2303-9027.212314
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author Iwasaki, Eisuke
Itoi, Takao
Minami, Kazuhiro
Kitago, Minoru
Hibi, Taizo
Kanai, Takanori
author_facet Iwasaki, Eisuke
Itoi, Takao
Minami, Kazuhiro
Kitago, Minoru
Hibi, Taizo
Kanai, Takanori
author_sort Iwasaki, Eisuke
collection PubMed
description A 76-years-old man who underwent pylorus-preserving pancreaticoduodenectomy for lower cholangiocarcinoma developed peritonitis with intra-abdominal abscess from anastomotic leakage. We have done a reoperation for surgical drainage and jejunostomy for intestinal decompression. After operation, pancreatic leakage from anastomosis of pancreatico-jejunum was detected using contrast medium from jejunostomy. We tried percutaneous drainage for abscess several times but could not treat pancreatic leakage completely over 6 months hospitalization. The pancreatic duct stenting from the intestine by balloon endoscopy was impossible because of adhesion. We tried antegrade stenting using endoscopic ultrasound-guided pancreatic drainage (EUS-PD). In EUS findings, we could identify main pancreatic duct with a diameter of 1.3 mm. It is too thin to insert the needle for EUS-PD. Therefore, we punctured it with a 22-gauge needle and succeeded pancreatography. Then, we inserted 0.018 inch guidewire, and it reached into the duct of pancreatic head. After expanding the puncture site by ultra-tapered dilator and standard dilation catheter step-wisely, the guidewire was exchanged to 0.025 inch hard-type guidewire. We placed a new 7 Fr plastic stent smoothly across the pancreatic duct (Through Pass Type IT, Gadelius Medical, Tokyo, Japan); the distal part was in the intestine, and the proximal part (pigtail) was in the gastric lumen. Pancreatic leakage was improved and patient was discharged. EUS-PD with newly developed tube stent may be considered as an effective therapy in selected patients with a pancreatic leakage after pancreatectomy.
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spelling pubmed-55698542017-09-01 Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy Iwasaki, Eisuke Itoi, Takao Minami, Kazuhiro Kitago, Minoru Hibi, Taizo Kanai, Takanori Endosc Ultrasound Abstract A 76-years-old man who underwent pylorus-preserving pancreaticoduodenectomy for lower cholangiocarcinoma developed peritonitis with intra-abdominal abscess from anastomotic leakage. We have done a reoperation for surgical drainage and jejunostomy for intestinal decompression. After operation, pancreatic leakage from anastomosis of pancreatico-jejunum was detected using contrast medium from jejunostomy. We tried percutaneous drainage for abscess several times but could not treat pancreatic leakage completely over 6 months hospitalization. The pancreatic duct stenting from the intestine by balloon endoscopy was impossible because of adhesion. We tried antegrade stenting using endoscopic ultrasound-guided pancreatic drainage (EUS-PD). In EUS findings, we could identify main pancreatic duct with a diameter of 1.3 mm. It is too thin to insert the needle for EUS-PD. Therefore, we punctured it with a 22-gauge needle and succeeded pancreatography. Then, we inserted 0.018 inch guidewire, and it reached into the duct of pancreatic head. After expanding the puncture site by ultra-tapered dilator and standard dilation catheter step-wisely, the guidewire was exchanged to 0.025 inch hard-type guidewire. We placed a new 7 Fr plastic stent smoothly across the pancreatic duct (Through Pass Type IT, Gadelius Medical, Tokyo, Japan); the distal part was in the intestine, and the proximal part (pigtail) was in the gastric lumen. Pancreatic leakage was improved and patient was discharged. EUS-PD with newly developed tube stent may be considered as an effective therapy in selected patients with a pancreatic leakage after pancreatectomy. Medknow Publications & Media Pvt Ltd 2017-08 /pmc/articles/PMC5569854/ http://dx.doi.org/10.4103/2303-9027.212314 Text en Copyright: © 2017 Endoscopic Ultrasound http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Abstract
Iwasaki, Eisuke
Itoi, Takao
Minami, Kazuhiro
Kitago, Minoru
Hibi, Taizo
Kanai, Takanori
Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title_full Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title_fullStr Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title_full_unstemmed Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title_short Asian EUS Cup-07: Endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
title_sort asian eus cup-07: endoscopic ultrasound-guided pancreatic duct stenting with a new plastic stent for nondilated pancreatic duct in pancreatic fistula after pancreaticoduodenectomy
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569854/
http://dx.doi.org/10.4103/2303-9027.212314
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