Rana Surinder S, Sharma Ravi, Ahmed Sobur Uddin, Gupta Rajesh
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2017 Sep;36(5):400-404. doi: 10.1007/s12664-017-0792-y. Epub 2017 Oct 2.
Acute necrotizing pancreatitis (ANP) is complicated with segmental portal hypertension (PHT) and formation of venous collaterals. Presence of collaterals in vicinity of endoscopic transmural tract can lead to potentially catastrophic situation. Here, we report safety and outcome of EUS-guided transmural drainage of walled-off pancreatic necrosis (WOPN) in patients with PHT and intra-abdominal collaterals.
Retrospective analysis of collected database of patients (n=18; age 40.94±8.43 years; 17 males) who underwent EUS-guided transmural drainage of WOPN and had PHT with collaterals.
Etiology of ANP: alcohol in 14 and gallstones in 3 patients. Mean size of collection was 10.7±3.5 cm, and all 18 patients had splenic vein thrombosis with 1 patient also having portal vein thrombosis. Drainage was not feasible in 1 patient as no window free of collaterals could be found. One patient with gastric variceal bleeding underwent drainage after successful obliteration of varix with glue. Multiple plastic stents were placed in 15 patients and fully covered self-expanding metallic stent (FCSEMS) in 1 patient and 1 patient required direct endoscopic necrosectomy (DEN). Mean procedures required were 3 ± 0.79 and time to resolution was 4.4 ± 1.3 weeks. One patient had post-drainage bleeding that was successfully managed with intravenous terlipressin and intermittent irrigation via nasocystic catheter. Successfully treated patients have been asymptomatic over follow up period of 15.65±12.2 weeks.
EUS-guided drainage of WOPN seems to be safe and effective in patients with portal hypertension and intra-abdominal collaterals.
急性坏死性胰腺炎（ANP）常并发节段性门静脉高压（PHT）及静脉侧支循环形成。内镜透壁通道附近存在侧支循环可导致潜在的灾难性后果。在此，我们报告经内镜超声引导下对伴有PHT和腹腔内有侧支循环的患者进行壁内胰腺坏死（WOPN）透壁引流的安全性及结果。
回顾性分析收集的数据库中接受经内镜超声引导下WOPN透壁引流且患有PHT及侧支循环的患者（n = 18；年龄40.94±8.43岁；17例男性）。
ANP的病因：14例为酒精性，3例为胆结石。积液平均大小为10.7±3.5cm，所有18例患者均有脾静脉血栓形成，1例患者还存在门静脉血栓形成。1例患者因未发现无侧支循环的窗口而无法进行引流。1例胃静脉曲张出血患者在成功用胶水闭塞静脉曲张后进行了引流。15例患者放置了多个塑料支架，1例患者放置了全覆膜自膨式金属支架（FCSEMS），1例患者需要直接内镜坏死组织切除术（DEN）。平均所需操作次数为3±0.79次，解决时间为4.4±1.3周。1例患者术后出血，通过静脉注射特利加压素及经鼻胆管间歇性冲洗成功处理。成功治疗的患者在15.65±12.2周的随访期内无症状。
对于门静脉高压和腹腔内有侧支循环的患者，经内镜超声引导下WOPN引流似乎是安全有效的。
