No abstract

Guidewire technique for bile duct cannulation lowers likelihood of post-ERCP pancreatitis by facilitating cannulation and reducing need for precut sphincterotomy.

Endoscopic biliary drainage is cheaper and provides better quality of life in patients with biliary obstruction and metastatic pancreatic cancer.

Pancreaticoduodenectomy is the only curative treatment for pancreatic head tumors. The possibility to achieve a potentially curative surgical treatment is limited to patients in which a complete tumor resection can be performed with free surgical margins. In a small number of patients with localized pancreatic cancer, negative margins are only accomplished with portal vein resection. Pancreaticoduodenectomy is often avoided in these patients due to the mistaken concept that venous resection may be followed by higher mortality and carries poorer survival. Actually, these patients present the same survival rate as patients similarly staged in whom portal vein resection was not performed. Therefore, venous resection is worthwhile. The authors describe an alternative technique for venous reconstruction after resection of a long segment of portal or superior mesenteric vein. The use of a venous graft as proposed in this study is feasible, easy to perform, and may simplify the venous reconstruction even in extensive mesentericoportal venous resection.

Deployment of covered SEMS without prior ES in patients with distal common bile duct obstruction owing to pancreatic cancer is feasible and prevents the development of complications such as stent migration, bleeding, and perforation.