Prophylactic pancreatic duct stenting in severe acute necrotizing pancreatitis: a prospective randomized study

Karjula, Heikki; Schmidt, Palle Nordblad; Mäkelä, Jyrki; Liisanantti, Janne; Ohtonen, Pasi; Saarela, Arto

doi:10.1055/a-0865-1960

Cited by 29 publications

(26 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although performing ERCP even earlier in the course of disease might have overcome some of the technical difficulties encountered, an even more important finding in this study is the infectious complications after (attempting) pancreatic duct placement: all five patients with successful stent placement, and two of the other six patients in whom stent placement was attempted, developed infected ANP, bringing the group total to 63.6 % (7/11), which was significantly higher than in the control group (23.1 %). Infection occurred much earlier (24 days) in patients with pancreatic stent placement than in those without (47.5 days), which further supports the notion that the introduction of these pancreatic stents was, at least partly, responsible for the infection [5].…”

supporting

confidence: 67%

“…In this issue of Endoscopy, Karjula et al took an original approach to address this problem [5]. Instead of waiting for local complications to occur in patients with ANP, the authors hypothesized that placement of a pancreatic stent early in the course of disease would help to maintain the integrity of the pancreatic duct, and by doing so prevent the complications of pancreatic fluid leakage that would require endoscopic, percutaneous or surgical intervention.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Bridging the gap or paving the way for uninvited guests?

Wanrooij¹,

Hooft²

2019

Endoscopy

View full text Add to dashboard Cite

The early phase of acute pancreatitis is characterized by a systemic inflammatory response that leads to necrosis of the pancreas parenchyma and/or the pancreatic fat tissue in about 20 % of patients [1]. Acute necrotizing pancreatitis (ANP) is commonly associated with pancreatic duct leakage resulting in extensive damage of the parenchyma and duct(s) of the pancreas, which in turn is associated with disconnected duct syndrome and persistent peripancreatic fluid collections [2]; vice versa, leakage of enzymatic active pancreatic fluid into the pancreas parenchyma is also thought to aggravate damage of the pancreas [2]. After 7-14 days, the inflammatory response attenuates, and during this late phase the course of disease is now mostly determined by whether or not necrotic tissue becomes infected, which occurs in about 30 % of patients with ANP [3]. Mortality rates in patients with infected ANP are high (30 %), and although recent developments in treatment approaches utilizing minimal invasive drainage strategies have improved outcomes, further progress is much needed [4].

show abstract

supporting

confidence: 67%

mentioning

confidence: 99%

Bridging the gap or paving the way for uninvited guests?

Wanrooij¹,

Hooft²

2019

Endoscopy

View full text Add to dashboard Cite

show abstract

“…To confirm this suspicion and the degree of disruption, the current reference standard to diagnose a disrupted or disconnected pancreatic duct is ERCP. This imaging modality is, however, invasive and increases the risk of infected necrosis and other complications in this patient population [ 30 , 31 ]. These risks do not occur with EUS or less invasive imaging modalities such as (secretin)-MRCP.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic modalities currently used are computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) with or without secretin, or pancreatography during surgery [ 8 , 13 , 17 , 21 – 29 ]. Nowadays, ERCP is still considered as the reference of standard, but this is an invasive procedure with a risk of complications such as secondary infection of pancreatic necrosis, flare of pancreatitis, bleeding and perforation [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Various Modalities Accurate in Diagnosing a Disrupted or Disconnected Pancreatic Duct in Acute Pancreatitis: A Systematic Review

et al. 2020

View full text Add to dashboard Cite

Background Severe pancreatitis may result in a disrupted pancreatic duct, which is associated with a complicated clinical course. Diagnosis of a disrupted pancreatic duct is not standardized in clinical practice or international guidelines. We performed a systematic review of the literature on imaging modalities for diagnosing a disrupted pancreatic duct in patients with acute pancreatitis. Methods A systematic search was performed in PubMed, Embase and Cochrane library databases to identify all studies evaluating diagnostic modalities for the diagnosis of a disrupted pancreatic duct in acute pancreatitis. All data regarding diagnostic accuracy were extracted. Results We included 8 studies, evaluating five different diagnostic modalities in 142 patients with severe acute pancreatitis. Study quality was assessed, with proportionally divided high and low risk of bias and low applicability concerns in 75% of the studies. A sensitivity of 100% was reported for endoscopic ultrasound and endoscopic retrograde cholangiopancreatography. The sensitivity of magnetic resonance cholangiopancreatography with or without secretin was 83%. A sensitivity of 92% was demonstrated for a combined cohort of secretin-magnetic resonance cholangiopancreatography and magnetic resonance cholangiopancreatography. A sensitivity of 100% and specificity of 50% was found for amylase measurements in drain fluid compared with ERCP. Conclusions This review suggests that various diagnostic modalities are accurate in diagnosing a disrupted pancreatic duct in patients with acute pancreatitis. Amylase measurement in drain fluid should be standardized. Given the invasive nature of other modalities, secretin-magnetic resonance cholangiopancreatography or magnetic resonance cholangiopancreatography would be recommended as first diagnostic modality. Further prospective studies, however, are needed. Electronic supplementary material The online version of this article (10.1007/s10620-020-06413-0) contains supplementary material, which is available to authorized users.

show abstract

“…[19][20][21] Rescue MPD stenting has been reported to prevent the evolution of pancreatitis, and should be done 8-20 hours from the onset of PEP. [22][23][24] Stents used for MPD stenting should be short (less then 5 cm, and small in diameter (5 French) and distally unflanged plastic stents. Unflanged stents can lead to spontaneous migration into the gastrointestinal tract, that occurs in 95% of cases within 10 days.…”

mentioning

confidence: 99%