Clinical influence of anastomotic stricture caused by pancreatogastrointestinalstomy following pancreatoduodenectomy

Murakami, Makoto; Katayama, Kanji; Kato, Shigeru; Fujimoto, Daisuke; Morikawa, Mitsuhiro; Kono, Kenji; Hirono, Yasuo; Goi, Takanori; Yamaguchi, Akio

doi:10.1007/s00595-016-1412-7

Cited by 2 publications

(7 citation statements)

References 13 publications

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“…Our results demonstrate that the statistical difference is significant between pancreatic duct obstruction and long-term pancreatic complications, regardless preoperatively ( p = 0.038) or postoperatively ( p = 0.002). This result is in accordance with previous studies [ 4 , 8 , 9 ], which speculated that pancreatic duct obstruction maybe a cause of long-term pancreatic complications including exocrine and endocrine insufficency. Although the overall exocrine pancreatic function is also influenced by the pancreatic stimulus, more attention has been paid on the pancreatic remnant reserve and pancreatic duct outflow [ 5 , 9 , 14 , 15 ].…”

Section: Discussionsupporting

confidence: 93%

“…Recent progress in surgical techniques and postoperative management have improved morbidity and motality of patients treated with PD [ 1 ]. On the contrary, long-term pancreatic complications such as endocrine and exocrine insufficiency have become important problems in the late postoperative period for patients with PD [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, little is known about the course of pancreatic endocrine and exocrine insufficiency after resection of pancreatic tumors [ 5 , 6 ], and the diagnosis of exocrine function is either complex or lack specificity [ 7 ]. Some studies of long-term results for patients with PD revealed that pancreatic endocrine and exocrine insufficiency may due to postoperative pancreatic duct obstruction, suggesting that the concern of postoperative pancreatic duct obstruction is essential [ 4 , 8 , 9 ]. In addition to endocrine and exocrine insufficiency, postoperative pancreatic duct obstruction may also cause pain, pancreatic duct stone and acute pancreatitis [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications

et al. 2018

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BackgroundPancreatic duct obstructions are common in patients with pancreaticoduodenectomy. However, it is often neglected in follow up. This study was to review the outcomes of pancreatic duct obstruction and explore the prevention of pancreatic duct obstruction.MethodsA retrospective analysis of 78 patients undergoing pancreaticojejunostomy without reccurence of disease within 24 months between 2004 and 2014. Pancreatic duct obstruction and long-term pancreatic complications were analysed.ResultsTwenty-five patients developed pancreatic duct obstruction following pancreaticojejunostomy, 13 of whom were found to have long-term pancreatic complications. The presence of pancreatic duct obstruction and early pancreatic obstruction were associated with long-term pancreatic complications, respectively (p = 0.002, p = 0.002). There are 10 patients with pancreatic duct stent more than 24 months, the postoperative median pancreatic parenchymal thickness in these 10 patients (17.1 mm, range 8.0 to 24.7 mm) was not significantly change than the median in them preoperative (16.4 mm, range 7.2 to 24.7 mm; p = 0.747). All of them have no long-term pancreatic complications, though the difference was not significantly (p = 0.068).ConclusionsEarly pancreatic duct obstruction is associated with postoperative pancreatic long-term complications. Sustained internal pancreatic stent may improve pancreatic duct obstruction.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications

et al. 2018

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“…Moreover, only patients without preoperative or postoperative pancreatic dilatation gained body weight. 13 In the present study, all six patients with difficult-todilate pancreatic nonanastomic benign strictures related to preexisting chronic pancreatitis that defied standard conventional dilation techniques were expected to develop adverse scenarios identical to those reported in the study by Murakami. 13 In the present study, the successful dilation of all pancreatic strictures using the SSR without concomitant balloon dilation despite subsequent stenting has contributed considerably to risk reduction, although tracking of the longterm outcomes of these patients is warranted.…”

Section: Discussionsupporting

confidence: 53%

“…The lowest atrophy rate (7.3%) was observed in patients without preoperative or postoperative pancreatic duct dilation. Moreover, only patients without preoperative or postoperative pancreatic dilatation gained body weight …”

Section: Discussionmentioning

confidence: 99%

Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

Chen

Ting

et al. 2019

Adv in Digestive Medicine

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Endoscopists frequently encounter severe tight strictures during therapeutic endoscopic retrograde cholangiopancreatography. Dilation using a Soehendra stent retriever (SSR) can be the approach of choice. However, reports of SSR use for the aforementioned strictures are scant. Patients presenting with strictures of the biliary or pancreatic ducts between July 2015 and March 2019 were prospectively screened. The aforementioned strictures allowed the passage of only a guidewire but denied 5.5‐French (Fr) catheter advancement and conventional balloon or catheter dilation. After guidewire passage and endoscopic sphincterotomy, an (7‐Fr) SSR was screwed clockwise over a guidewire and advanced progressively to traverse and dilate the stricture proximally. A plastic stent was then placed in the biliary or pancreatic duct for internal drainage. The stricture and procedural characteristics and immediate postprocedural status were analyzed. Eleven patients (nine men and two women; median age 58 [range 43‐75] years) with severe benign strictures of the biliary (n = 5) or pancreatic (n = 6) ducts were included. The median length of the strictures was 5 (range 2‐9) mm. All 11 severe strictures were successfully dilated using an SSR followed by stenting with a plastic stent (range 5‐7 Fr). Only one patient had brief minor hemobilia immediately after the procedure, and another briefly experienced acute cholangitis. Five (5/6, 83.3%) patients in the pancreatic group eventually achieved stent removal. None of the patients achieved stent removal in the biliary duct group until the end of follow‐up. Nonetheless, the patients did not require percutaneous or surgical interventions. Dilation using the SSR is safe, tolerable, and successful for the tight biliary and pancreatic duct strictures that defy conventional wire‐guided endoscopic access.

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Clinical influence of anastomotic stricture caused by pancreatogastrointestinalstomy following pancreatoduodenectomy

Cited by 2 publications

References 13 publications

Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications

Pancreatic duct obstruction after pancreaticojejunostomy: implications for early prediction and prevention of long-term pancreatic complications

Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

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