Endoscopic drainage of pancreatic pseudocysts

Kozarek, Richard A.; Brayko, Craig M.; Harlan, John R.; Sanowski, Robert A.; Cintora, Ismar; Kovac, Alexander

doi:10.1016/s0016-5107(85)72215-8

Cited by 202 publications

(75 citation statements)

References 15 publications

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“…The relapse rate was 9% after ECD and 19% after ECG. In our experience, pre viously published [25,26], no significant complications were observed after successful ECD and clinical relief of pain was achieved in 20 patients, ECD being an effective and definitive treatment for 19 out of 22 cases.…”

Section: Wall Stent Biliary Stentingmentioning

confidence: 61%

Endoscopic Management of Chronic Pancreatitis

Cremer¹,

Devière²,

Dumonceau³

et al. 1994

Dig Surg

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The indications of endoscopic management for chronic pancreatitis are strictly related to the classification of severe types and to the particular anatomy of the ducts. (1) Impacted or distal calculi without stricture: ESWL followed by EPS and extraction of fragments. (2) Stone(s) and stricture: ESWL, EPS, NPC, and then 10-french plastic stenting. (3) Relapsing strictures (with upward dilatation) after 6-12 months’ stenting: coated self-expanding stent (in a prospective trial), versus surgical laterolateral pancreaticojejunostomy (Partington-Ro-chelle operation). (4) Paraduodenal cyst bulging into the duodenum: ECD ± stenting. (5) Retrogastric pseudocyst: ECG and stenting. (6) Jaundice and/or cholestasis due to stricture of the intrapancreatic CBD: 10-french single or multiple plastic stents for calibration during 3 months. For relapsing cholestasis and stricture, 30-french metal mesh stent versus surgical hepaticojejunostomy. Due to the tremendous variations of the ducts’ anatomy, the method includes drainage through the minor papilla for patients with a dominant Santorini or dorsal duct (table 6). The indications of endoscopic management for chronic pancreatitis are specific and require complete imaging and functional check-up (ERCP, CT scanner, endosonography, pancreatic function tests). The technique is quite difficult and requires high-definition fluoroscopy, appropriate devices and experienced gastrointestinal assistents and radiologists. On these conditions, the complication rate is very low and can usually be medically controlled. Treatment does not compromise any further surgery. Endoscopy makes it possible to avoid or to postpone surgery, the indication for which might become better defined and the patients more carefully selected in the future.

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Section: Wall Stent Biliary Stentingmentioning

confidence: 61%

Endoscopic Management of Chronic Pancreatitis

Cremer¹,

Devière²,

Dumonceau³

et al. 1994

Dig Surg

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“…Die ersten Grundlagen wurden bereits Mitte der 1990er-Jahre des letzten Jahrhunderts geschaffen, damals noch transpapillär oder auch schon transmural [11,12,13]. Baron et al [14] führten die nasozystische Spülung parallel zu einer nasozystischen Kunststoffstentdrainage ein.…”

Section: Endoskopische Verfahrenunclassified

Endoskopie als Baustein der interventionellen Therapie infizierter Pankreasnekrosen

Fellermann¹

2013

Visc Med

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Hintergrund: Die Mortalität von Pankreatitiden wird - abgesehen vom Organversagen - meist nicht durch akute Komplikationen, sondern durch Spätfolgen bestimmt. Gefürchtet sind hierbei die infektbedingten Veränderungen wie z.B. die infizierten Nekrosen. Eine Nekrosektomie gilt dabei nach wie vor als das Verfahren der Wahl, wohl wissend, dass sich die Prognose des Patienten damit verschlechtert. Methode und Ergebnisse: Unter Berücksichtigung der aktuellen Literatur - speziell der neuen Einteilung pankreatischer Flüssigkeitskollektionen - werden die derzeit verfügbaren Techniken und Herangehensweisen gegenübergestellt. Schlussfolgerung: Weniger invasive oder beeinträchtigende Verfahren lösen ein radikales Vorgehen mehr und mehr ab, wobei nicht jeder größere Eingriff verhindert werden kann. Das Zusammenspiel diverser Fachrichtungen ist gefordert und sollte bestmöglich nach einem Step-up-Ansatz erfolgen, indem minimal invasiv begonnen wird und die offene Nekrosektomie eine Ausnahme bleiben sollte. Es gilt nach wie vor der Leitspruch «ubi pus, ibi evacua».

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“…Die Be handlung bestand zunächst in der trans gastromuralen Eröffnung von Pseudo zysten mittels Nadelmesserinzision [3,4,5]. Mit der Einführung von Echoendo skopen wurde es möglich, unter endo sonographischer (EUS)Sicht auch Befun de ohne Pelottierung der Wand zu punk tieren [6].…”

Section: Entwicklung Des Verfahrensunclassified

Pankreasnekrose: Pro endoskopische Therapie

Dahl

Seifert

2011

Chirurg

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The transmural endoscopic debridement and other minimally invasive therapies of infected postpancreatic necroses have been developed over the last decade as alternatives to open surgery. In several clinical centers the endoscopic approach has become standard therapy. The mortality rate in published series is in the range 0-15% and additional surgery is needed in 0-40%.Out of 73 own patients treated endoscopically between 2006 and 2010, 4 were operated because of bleeding, 2 with an acute abdomen and 3 with sepsis. Of the patients 6 died because of multi-organ failure and in 3 cases despite surgery. Main complications such as bleeding (n=20) and acute abdomen (n=7) were mostly treated conservatively. There was no procedure-related mortality. The endoscopic therapy was successful in 59 patients (80%) of whom 7 required further transmural endoscopic interventions for cystic relapses.At present, finding the best combination of endoscopic-transmural, percutaneous, laparoscopic and sometimes finally open surgical therapy remains an interdisciplinary challenge. The only randomized study published in this context clearly indicates that such a step-up approach is the most favorable.

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Endoscopic drainage of pancreatic pseudocysts

Cited by 202 publications

References 15 publications

Endoscopic Management of Chronic Pancreatitis

Endoscopic Management of Chronic Pancreatitis

Endoskopie als Baustein der interventionellen Therapie infizierter Pankreasnekrosen

Pankreasnekrose: Pro endoskopische Therapie

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