A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption
Background and Aims Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of p...
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| Veröffentlicht in: | Digestive diseases and sciences 2023-09, Vol.68 (9), p.3745-3755 |
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| creator | Ödemiş, Bülent Durak, Muhammed Bahaddin Atay, Ali Başpınar, Batuhan Erdoğan, Çağdaş |
| description | Background and Aims
Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach.
Methods
This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (
n
= 26) or traumatic (
n
= 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and
N
-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption.
Results
PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients.
Conclusions
Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities. |
| doi_str_mv | 10.1007/s10620-023-07996-0 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2829706546</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A761884472</galeid><sourcerecordid>A761884472</sourcerecordid><originalsourceid>FETCH-LOGICAL-c393t-6637ad3bb836c1179e6c729b55fc186ababcbc3d6dc45c3a639f9eeb823d736f3</originalsourceid><addsrcrecordid>eNp9ksFu1DAQhiMEokvhBTggS1y4pNhxYsfHqF2gUhGV2j1bjjNeXCV2sB2kvgTPjHdTqEAI-eCx_f2_ZsZTFK8JPiMY8_eRYFbhEle0xFwIVuInxYY0nJZVw9qnxQYTlmNC2EnxIsY7jLHghD0vTiinTcso3xQ_OnSTYC53M-rmOXilv6JdtG6PujFBcCrZ74C2bvBR-9lq9NkParTJQkSXESmHtsaAPlI3KagE-3tkfEDXPiY_Q1gNlBvQbVDLlI8aXSunAxzDi0UndGFjWOZkvXtZPDNqjPDqYT8tdh-2t-efyqsvHy_Pu6tSU0FTyXLuaqB931KmCeECmOaV6JvGaNIy1ate95oObNB1o6liVBgB0LcVHThlhp4W71bfXPK3BWKSk40axlE58EuUVVsJjllTs4y-_Qu980tuzHigMsBF09aP1F6NIK0zPjdDH0xlxxlp27rmVabO_kHlNcBktXdgbL7_Q1CtAh18jAGMnIOdVLiXBMvDEMh1CGQeAnkcAomz6M1Dxks_wfBb8uvXM0BXIOYnt4fwWNJ_bH8CeAO9Iw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2854679584</pqid></control><display><type>article</type><title>A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption</title><source>SpringerLink Journals</source><creator>Ödemiş, Bülent ; Durak, Muhammed Bahaddin ; Atay, Ali ; Başpınar, Batuhan ; Erdoğan, Çağdaş</creator><creatorcontrib>Ödemiş, Bülent ; Durak, Muhammed Bahaddin ; Atay, Ali ; Başpınar, Batuhan ; Erdoğan, Çağdaş</creatorcontrib><description>Background and Aims
Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach.
Methods
This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (
n
= 26) or traumatic (
n
= 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and
N
-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption.
Results
PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients.
Conclusions
Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-023-07996-0</identifier><identifier>PMID: 37358637</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Algorithms ; Biochemistry ; Cysts ; Endoscopy ; Gastroenterology ; Health aspects ; Hepatology ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Oncology ; Original Article ; Stent (Surgery) ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2023-09, Vol.68 (9), p.3745-3755</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c393t-6637ad3bb836c1179e6c729b55fc186ababcbc3d6dc45c3a639f9eeb823d736f3</cites><orcidid>0000-0002-3914-7531</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-023-07996-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-023-07996-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37358637$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ödemiş, Bülent</creatorcontrib><creatorcontrib>Durak, Muhammed Bahaddin</creatorcontrib><creatorcontrib>Atay, Ali</creatorcontrib><creatorcontrib>Başpınar, Batuhan</creatorcontrib><creatorcontrib>Erdoğan, Çağdaş</creatorcontrib><title>A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background and Aims
Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach.
Methods
This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (
n
= 26) or traumatic (
n
= 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and
N
-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption.
Results
PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients.
Conclusions
Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.</description><subject>Algorithms</subject><subject>Biochemistry</subject><subject>Cysts</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Stent (Surgery)</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9ksFu1DAQhiMEokvhBTggS1y4pNhxYsfHqF2gUhGV2j1bjjNeXCV2sB2kvgTPjHdTqEAI-eCx_f2_ZsZTFK8JPiMY8_eRYFbhEle0xFwIVuInxYY0nJZVw9qnxQYTlmNC2EnxIsY7jLHghD0vTiinTcso3xQ_OnSTYC53M-rmOXilv6JdtG6PujFBcCrZ74C2bvBR-9lq9NkParTJQkSXESmHtsaAPlI3KagE-3tkfEDXPiY_Q1gNlBvQbVDLlI8aXSunAxzDi0UndGFjWOZkvXtZPDNqjPDqYT8tdh-2t-efyqsvHy_Pu6tSU0FTyXLuaqB931KmCeECmOaV6JvGaNIy1ate95oObNB1o6liVBgB0LcVHThlhp4W71bfXPK3BWKSk40axlE58EuUVVsJjllTs4y-_Qu980tuzHigMsBF09aP1F6NIK0zPjdDH0xlxxlp27rmVabO_kHlNcBktXdgbL7_Q1CtAh18jAGMnIOdVLiXBMvDEMh1CGQeAnkcAomz6M1Dxks_wfBb8uvXM0BXIOYnt4fwWNJ_bH8CeAO9Iw</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Ödemiş, Bülent</creator><creator>Durak, Muhammed Bahaddin</creator><creator>Atay, Ali</creator><creator>Başpınar, Batuhan</creator><creator>Erdoğan, Çağdaş</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3914-7531</orcidid></search><sort><creationdate>20230901</creationdate><title>A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption</title><author>Ödemiş, Bülent ; Durak, Muhammed Bahaddin ; Atay, Ali ; Başpınar, Batuhan ; Erdoğan, Çağdaş</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-6637ad3bb836c1179e6c729b55fc186ababcbc3d6dc45c3a639f9eeb823d736f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Algorithms</topic><topic>Biochemistry</topic><topic>Cysts</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Health aspects</topic><topic>Hepatology</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Stent (Surgery)</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ödemiş, Bülent</creatorcontrib><creatorcontrib>Durak, Muhammed Bahaddin</creatorcontrib><creatorcontrib>Atay, Ali</creatorcontrib><creatorcontrib>Başpınar, Batuhan</creatorcontrib><creatorcontrib>Erdoğan, Çağdaş</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ödemiş, Bülent</au><au>Durak, Muhammed Bahaddin</au><au>Atay, Ali</au><au>Başpınar, Batuhan</au><au>Erdoğan, Çağdaş</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>68</volume><issue>9</issue><spage>3745</spage><epage>3755</epage><pages>3745-3755</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background and Aims
Standard endotherapy for pancreatic duct (PD) disruption is pancreatic stenting and sphincterotomy. In patients refractory to standard treatment, treatment algorithm is currently not standardized. This study aims to report the 10-year experience with the endoscopic treatment of postoperative or traumatic PD disruption and to share our algorithmic approach.
Methods
This retrospective study was conducted on 30 consecutive patients who underwent endoscopic treatment for postoperative (
n
= 26) or traumatic (
n
= 4) PD disruption between 2011 and 2021. Standard treatment was initially applied to all patients. Endoscopic modalities used with a step-up approach in patients unresponsive to standard treatment were stent upsizing and
N
-butyl-2-cyanoacrilate (NBCA) injection for partial disruption, and the bridging of the disruption with a stent and cystogastrostomy for complete disruption.
Results
PD disruption was partial in 26 and complete in 4 patients. Cannulation and stenting of PD was successful in all patients and sphincterotomy was performed in 22 patients. Standard treatment was successful in 20 patients (66.6%). The resolution of PD disruption in 9 of 10 patients refractory to standard treatment was achieved with stent upsizing in 4, NBCA injection in 2, the bridging of the complete disruption in one, and cystogastrostomy after spontaneously and intentionally developed pseudocyst in one patient each. Overall, therapeutic success rate was 96.6% (100% for partial, 75% for complete disruption). Procedural complications occurred in 7 patients.
Conclusions
Standart treatment for PD disruption is usually effective. In patients refractory to standard treatment, the outcome may be improved by step-up approach using alternative endoscopic modalities.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37358637</pmid><doi>10.1007/s10620-023-07996-0</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3914-7531</orcidid></addata></record> |
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| language | eng |
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| source | SpringerLink Journals |
| subjects | Algorithms Biochemistry Cysts Endoscopy Gastroenterology Health aspects Hepatology Medical research Medicine Medicine & Public Health Medicine, Experimental Oncology Original Article Stent (Surgery) Transplant Surgery |
| title | A Step-Up Approach Using Alternative Endoscopic Modalities Is an Effective Strategy for Postoperative and Traumatic Pancreatic Duct Disruption |
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