Xu Ning, Li Long-Song, Yue Wen-Yi, Zhao Dan-Qi, Xiang Jing-Yuan, Zhang Bo, Wang Peng-Ju, Cheng Ya-Xuan, Linghu En-Qiang, Chai Ning-Li
Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China.
Department of Radiology, Chinese PLA General Medical School, Beijing 100853, China.
World J Gastrointest Surg. 2022 Aug 27;14(8):855-861. doi: 10.4240/wjgs.v14.i8.855.
Endoscopic ultrasound (EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections (PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.
Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography (CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.
Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.
内镜超声（EUS）引导下腔内引流是一种用于治疗胰腺液体积聚（PFCs）的先进技术。然而，胃静脉曲张和介入血管可能与高出血风险相关，因此被列为相对禁忌证。在此，我们报告两例在EUS引导下引流前接受介入栓塞治疗的患者。
两名32岁男性在急性胰腺炎后出现有症状的PFCs，并前来我院进一步治疗。一名患者出现间歇性腹痛和呕吐，计算机断层扫描（CT）成像显示一个大小为7.93 cm×6.13 cm的包裹性囊肿。另一名患者主诉腹部有肿块，且逐渐增大。在我们评估两名患者的内镜引流可能性时，EUS均检测到理想穿刺部位周围存在胃静脉曲张。建议先行介入栓塞以降低出血风险。之后，成功进行了EUS引导下腔内引流，未发生血管破裂。住院期间未出现术后并发症，在术后1个月进行的最后一次CT随访扫描中未发现复发。
对于存在胃静脉曲张或有高出血风险的PFC患者，介入栓塞是在EUS引导下引流前进行的一种安全的术前操作。
