Chronic Pancreatitis with Benign Biliary Obstruction: Management Issues

Saluja, Sundeep Singh; Kalayarasan, Raja; Mishra, Pramod Kumar; Srivastava, Siddharth; Chandrasekar, Sandip; Godhi, Satyajit

doi:10.1007/s00268-014-2581-4

Cited by 10 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pancreatojejunostomy was done using single layer continuous (using 3-0 polydioxanone) sutures in all the patients. As previously reported patients who had biliary obstruction secondary to CP underwent biliary drainage by Roux-en-Y hepaticojejunostomy 9. A single closed tube drain was placed near the pancreatojejunostomy site and brought out through left flank in all the patients.…”

Section: Methodsmentioning

confidence: 91%

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

Vijayaraj

Kalayarasan

Gnanasekaran

et al. 2019

Ann Hepatobiliary Pancreat Surg

Self Cite

View full text Add to dashboard Cite

Backgrounds/AimsAbdominal drains are routinely placed following Frey procedure for chronic pancreatitis (CP) despite the low incidence of pancreatic fistula (PF). The utility of the first postoperative day (POD1) drain fluid amylase (DFA) value in predicting PF in CP patients undergoing Frey procedure has not been previously reported.MethodsA prospective study of patients with CP who underwent Frey procedure between August 2014 and April 2018. A standard technique of head coring with single layer continuous pancreatojejunostomy was done in all the patients. Amylase level of the drain placed close to the pancreatojejunostomy was recorded on POD1 and 3. Postoperative PF was defined and graded as per the updated International Study Group of Pancreatic Fistula (ISGPF) guidelines.ResultsFifty-five patients with CP who fulfilled the inclusion criteria were included in the study. All had normal preoperative serum amylase level. Three patients developed a biochemical leak and four patients developed postoperative PF (Grade B - 3 and Grade C - 1). Receiver operating characteristics (ROC) curve identified a POD1 DFA cut-off value of 326 U/L that predicted a postoperative PF with sensitivity, specificity and negative predictive value of 100%, 70%, and 100% respectively.ConclusionsThe POD1 DFA is a reliable predictor of postoperative PF in CP patients who have undergone Frey procedure. The PF can be confidently excluded in patients who have a POD1 DFA less than 326 U/L.

show abstract

Section: Methodsmentioning

confidence: 91%

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

Vijayaraj

Kalayarasan

Gnanasekaran

et al. 2019

Ann Hepatobiliary Pancreat Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Patients with chronic pancreatitis are also at a higher risk of malignancy. 13,14 Due to the complex and varied nature of biliary anatomy, it is important to correctly identify and diagnose patients presenting with biliary symptoms to avoid any operative or postoperative complications. The main aim of any imaging modality should be to identify the presence of any obstruction(s), its location, extent, and also any potential etiology.…”

Section: Discussionmentioning

confidence: 99%

The Synergistic Role of Integrated Computed Tomography and Magnetic Resonance Cholangiopancreatography in Disorders of the Pancreatobiliary System

Rai,

Srivastava,

Gopal

et al. 2023

Journal of Gastrointestinal and Abdominal Radiology

View full text Add to dashboard Cite

Objective The aim of the study was to evaluate the synergistic role and advantages of integrating noncontrast computed tomography (NCCT) and magnetic resonance cholangiopancreatography (MRCP) in disorders of the pancreatobiliary (PB) system. Methods In this cross-sectional and retrospective record-based study, radiological (NCCT and MRCP) data were collected retrospectively for a period of 3 years (June 2018–August 2020) from 52 patients. The results were compared to the final diagnosis on endoscopic retrograde cholangiopancreatography (ERCP) findings (gold standard). The data collected were analyzed by measuring the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and p-value for NCCT, MRCP, and integrated NCCT plus MRCP at different cutoff points. Subsequently, a receiver operating characteristic (ROC) curve was plotted to analyze different thresholds for NCCT, MRCP, and integrated NCCT plus MRCP. Results The most common pathologies identified were biliary dilations (18.4%), common bile duct (CBD) calculi (13.6%), and biliary strictures (12.0%). Overall, MRCP provided a higher percentage of correct diagnoses (81.6%) compared to CT (56.0%). Integrating NCCT with MRCP showed a significant increase in sensitivities and specificities when compared to NCCT or MRCP alone. Integrated NCCT plus MRCP showed excellent performance with an area under the curve (AUC) of ROC analysis of 0.937. Conclusion Our study showed that integrating NCCT and MRCP can prove to be an excellent tool in establishing a detailed diagnosis of PB disorders, better than either NCCT or MRCP alone. Due to the concurrent nature of PB disorders, it may be worth considering integrating NCCT and MRCP, given that there is an absence of contraindications to either modality.

show abstract

“…Cuando las estenosis son identificadas es importante excluir malignidad. Los pacientes pueden experimentar dolor, náuseas, pérdida de peso, ictericia, prurito y el 10 % puede progresar y desarrollar colangitis o cirrosis biliar (32).…”

Section: Terapia Endoscópica En La Estenosis Biliar Por Pcunclassified

Intervencionismo endoscópico en la pancreatitis crónica

Llano

Artifon²

2019

Rev Colomb Gastroenterol

View full text Add to dashboard Cite

La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.

show abstract

Chronic Pancreatitis with Benign Biliary Obstruction: Management Issues

Abstract: BBO is common in patients with CP; however, biliary drainage is not indicated for chronic nonprogressive elevation of SAP. In patients with a progressive increase in SAP or persistent jaundice, both CDJ and CDD provide effective biliary drainage.

Cited by 10 publications

References 27 publications

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

The Synergistic Role of Integrated Computed Tomography and Magnetic Resonance Cholangiopancreatography in Disorders of the Pancreatobiliary System

Intervencionismo endoscópico en la pancreatitis crónica

Contact Info

Product

Resources

About