Tu1791 Biliary Stenosis and Gastric Outlet Obstruction: Complications After Acute Pancreatitis

Sugimoto, Motokazu; Flint, Greggory S.; Kirkham, John C.; Boyce, Cody J.; Harris, Tyler J.; Carr, Sean; Sonntag, David P.; Nelson, Brent D.; Barton, Joshua; Traverso, L.William

doi:10.1016/s0016-5085(15)34040-3

Cited by 4 publications

(14 citation statements)

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“…Based on the different operation methods, 49 patients who underwent traditional laparotomy under laparoscopic surgery were included in group A (31 males and 18 females, with an average age of 45.30±3.79 years) and 45 patients who underwent duodenoscopy and laparoscopic duodenoscopy for the nipple and pancreatic pseudocyst drainage treatment were included in group B (30 males and 15 females, with an average age of 44.94±3.89 years). Inclusion criteria: Participants were all patients in Weifang People's Hospital (Weifang, China); the diagnostic criteria were in accordance with the diagnostic criteria for clinical SAP (12); patients were diagnosed with SAP complicated with PP by abdominal Doppler ultrasound, CT and other imaging examinations, and all of them presented secondary infection of acute PP before treatment; patients did not receive relevant antibacterial, anti-inflammatory or glucocorticoid treatment before surgery. Exclusion criteria: Patients complicated with severe liver and kidney dysfunction, coagulation disorders, or cognitive impairment and communication impairment; patients who had received treatment that could influence the operation methods before surgery, or those who did not cooperate with the examination.…”

Section: Methodsmentioning

confidence: 99%

Clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis and pancreatic pseudocyst, and the effects on IL‑6 and CRP

et al. 2020

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The study aimed to investigate the clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis (SAP) and pancreatic pseudocyst (PP), and its effects on serum inflammatory factors. Altogether 94 patients complicated with SAP and PP who were admitted to Weifang People's Hospital (Weifang, China) from September 2015 to December 2018 were included. Based on the different operation methods, 49 patients who underwent traditional laparotomy under laparoscopic surgery were included in group A, and 45 patients who underwent duodenoscopy and laparoscopy under duodenoscope to treat the drainage of nipple and pancreatic pseudocysts were included in group B. The expression levels of related serum indexes and serum stress indexes before and at 48 h after surgery, the postoperative nausea, vomiting and abdominal pain scores, as well as the clinical efficacy, perioperative related indexes, recovery and complications were compared between the two groups. The prognostic factors in both groups were assessed via Logistic univariate and multivariate analyses. C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-β (IL-β), endotoxin and nuclear factor κB (NF-κB) were significantly lower in group B than those in group A (P<0.001). Upregulating cortisol and norepinephrine in group B was lower than that in group A (P<0.001). The total effective rate in group B was higher than that in group A (P<0.05). The perioperative related indexes, recovery, and postoperative complications in group B were better than those in group A (P<0.05). Scores of abdominal pain, nausea and vomiting in group B were markedly lower than those in group A (P<0.001). Multivariate Logistic regression analysis showed that CRP, TNF-α, IL-6, IL-β and surgical methods were independent risk factors for the prognosis of patients with SAP and PP. In conclusion, the combined treatment with duodenoscopy and laparoscopic surgery has little inflammatory and stress reaction, and it is highly safe, worthy to be popularized.

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Section: Methodsmentioning

confidence: 99%

Clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis and pancreatic pseudocyst, and the effects on IL‑6 and CRP

et al. 2020

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“…Biliary stricture is a known complication of chronic pancreatitis and occurs in 3-21% of CP patients in large series 10,11 ; however, the incidence of biliary stricture in NP patients to date has not been systematically described. Only one moderate sized study has reported the incidence of biliary stricture to be 6% of 141 AP patients with a fluid collection 16 . In this series, biliary stricture was diagnosed a median of 150 days after AP onset 16 , similar to our experience.…”

Section: Discussionmentioning

confidence: 99%

“…Only one moderate sized study has reported the incidence of biliary stricture to be 6% of 141 AP patients with a fluid collection 16 . In this series, biliary stricture was diagnosed a median of 150 days after AP onset 16 , similar to our experience. In this study by Sugimoto et al the incidence of biliary stricture was highest in patients with disconnected pancreatic duct syndrome (19%) 16 .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the true incidence of biliary stricture in acute pancreatitis (AP) and its impact on patient outcomes is not known. Case reports and case series of NP patients undergoing necrosectomy have described biliary stricture as a complication, but this complication has not been systematically characterized in a large cohort of NP patients [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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779 Biliary Stricture After Necrotizing Pancreatitis: An Underappreciated Challenge

Maatman¹,

Ceppa²,

Easler³

et al. 2020

Gastroenterology

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“…In many studies, late BS is associated to pancreatic duct disruption (PDD) with pancreatic juice leakage when duct of the head/neck of pancreas is involved in pancreatic necrosis [68]. When PDD is suspected, contrast-enhanced CT should be performed to confirm it and after that an endoscopic retrograde cholangiopancreatography (ERCP) to localize the leakage and positioning a stent [69].…”

Section: Biliary and Duodenal Complicationsmentioning

confidence: 99%

Surgical and Interventional Management of Complications Caused by Pancreatitis

Stecca¹,

Pauletti²,

Bonariol³

et al. 2022

Recent Advances in Pancreatitis

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Acute pancreatitis has a broad clinical spectrum: from mild, self-limited disease to fulminant illness resulting in multi-organ failure leading to a prolonged clinical course with up to 30% mortality in case of infected necrosis. Management of local complications such as pseudocysts and walled-off necrosis may vary from clinical observation to interventional treatment procedures. Gram negative bacteria infection may develop in up to one-third of patients with pancreatic necrosis leading to a clinical deterioration with the onset of the systemic inflammatory response syndrome and organ failure. When feasible, an interventional treatment is indicated. Percutaneous or endoscopic drainage approach are the first choices. A combination of minimally invasive techniques (step-up approach) is possible in patients with large or multiple collections. Open surgical treatment has been revised both in the timing and in the operating modalities in the last decades. Since 1990s, the surgical treatment of infected necrosis shifted to a more conservative approach. Disruption of the main pancreatic duct is present in up to 50% of patients with pancreatic fluid collections. According to the location along the Wirsung, treatment may vary from percutaneous drainage, endoscopic retrograde pancreatography with sphincterectomy or stenting to traditional surgical procedures. Patients may suffer from vascular complications in up to 23% of cases. Tissue disruption provoked by lipolytic and proteolytic enzymes, iatrogenic complications during operative procedures, splenic vein thrombosis, and pseudoaneurysms are the pathophysiological determinants of bleeding. Interventional radiology is the first line treatment and when it fails or is not possible, an urgent surgical approach should be adopted. Chylous ascites, biliary strictures and duodenal stenosis are complications that, although uncommon and transient, may have different treatment modalities from non-operative, endoscopic to open surgery.

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Tu1791 Biliary Stenosis and Gastric Outlet Obstruction: Complications After Acute Pancreatitis

Cited by 4 publications

References 0 publications

Clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis and pancreatic pseudocyst, and the effects on IL‑6 and CRP

Clinical efficacy of duodenoscopy combined with laparoscopy in the treatment of patients with severe acute pancreatitis and pancreatic pseudocyst, and the effects on IL‑6 and CRP

779 Biliary Stricture After Necrotizing Pancreatitis: An Underappreciated Challenge

Surgical and Interventional Management of Complications Caused by Pancreatitis

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