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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2017
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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. |
format | Online Article Text |
id | pubmed-5569854 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
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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