Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
Gastrointest Endosc. 2011 Feb;73(2):376-82. doi: 10.1016/j.gie.2010.10.015.
Pancreatodigestive tract anastomotic site stenosis is a problematic complication after pancreatoduodenectomy.
We evaluated the feasibility and efficacy of endoscopic treatments for a stenotic pancreatodigestive tract anastomosis.
Retrospective study.
Endoscopic units of a university-affiliated hospital and a general hospital.
Fourteen patients with recurrent pancreatitis (n=10) and pancreatic fluid fistula (n=4) after anatomy-altering surgery with pancreatodigestive tract anastomosis.
The initial ERCP included obtaining a pancreatogram, introducing a 0.025-inch guidewire through the anastomosis, along which a 5F plastic stent or nasopancreatic drain was inserted. If initial ERCP failed, we attempted EUS-guided rendezvous, with a guidewire passed antegrade from the main pancreatic duct across the stenotic anastomosis.
Rates of successful intervention and clinical relief.
The initial intervention was successfully achieved in 6 of 14 patients (38%). Of the 6 patients with successful therapeutic endoscopies, 4 (66.7%) and 2 (25.0%) had undergone a previous pancreatogastrostomy or pancreatojejunostomy, respectively. Eight patients with an initial unsuccessful intervention successfully underwent a second intervention using an EUS-guided or US-guided rendezvous method. Finally, stenosis was relieved in all patients with either the retrograde placement of a pancreatic duct stent across the stenosis of an anastomotic site or antegrade percutaneous bougienage of the stenotic anastomosis.
Small sample size and lack of control patients.
Endoscopic treatment of stenotic pancreatodigestive tract anastomosis for transanastomotic pancreatic juice drainage is safe and feasible.
胰肠吻合口狭窄是胰十二指肠切除术后的一个棘手的并发症。
评估内镜治疗胰肠吻合口狭窄的可行性和疗效。
回顾性研究。
大学附属医院和综合医院的内镜科室。
14 例因解剖改变手术导致胰肠吻合的患者，其中复发性胰腺炎 10 例，胰液漏 4 例。
初始 ERCP 包括获取胰管造影，将 0.025 英寸导丝穿过吻合口，沿导丝插入 5F 塑料支架或鼻胰管引流管。如果初始 ERCP 失败，则尝试 EUS 引导的会师技术，将导丝从前主胰管穿过狭窄的吻合口逆行插入。
介入治疗成功率和临床缓解率。
14 例患者中，有 6 例（38%）初始干预成功。在 6 例成功治疗性内镜治疗的患者中，4 例（66.7%）和 2 例（25.0%）分别进行了先前的胰胃吻合术或胰肠吻合术。8 例初始干预不成功的患者成功地进行了第二次干预，采用 EUS 引导或 US 引导的会师技术。最终，所有患者均通过逆行放置胰管支架穿过吻合口狭窄部位或顺行经皮扩张狭窄吻合口来缓解狭窄。
样本量小，缺乏对照患者。
内镜治疗胰肠吻合口狭窄以进行跨吻合胰液引流是安全可行的。
