Kim Ki-Hyun, Park Chang Hwan, Cho Eunae, Lee Yohan
Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea.
Department of Gastroenterology, Chonnam National University Hospital, Gwangju 61469, South Korea.
World J Clin Cases. 2024 Mar 26;12(9):1677-1684. doi: 10.12998/wjcc.v12.i9.1677.
Pancreatic ductal leaks complicated by endoscopic ultrasonography-guided tissue sampling (EUS-TS) can manifest as acute pancreatitis.
A 63-year-old man presented with persistent abdominal pain and weight loss. Diagnosis: Laboratory findings revealed elevated carbohydrate antigen 19-9 (5920 U/mL) and carcinoembryonic antigen (23.7 ng/mL) levels. Magnetic resonance imaging of the pancreas revealed an approximately 3 cm ill-defined space-occupying lesion in the inferior aspect of the head, with severe encasement of the superior mesenteric artery. Pancreatic ductal adenocarcinoma was confirmed after pathological examination of specimens obtained by EUS-TS using the fanning method. Interventions and outcomes: The following day, the patient experienced severe abdominal pain with high amylase (265 U/L) and lipase (1173 U/L) levels. Computed tomography of the abdomen revealed edematous wall thickening of the second portion of the duodenum with adjacent fluid collections and a suspicious leak from either the distal common bile duct or the main pancreatic duct in the head. Endoscopic retrograde cholangiopancreatography revealed dye leakage in the head of the main pancreatic duct. Therefore, a 5F 7 cm linear plastic stent was deployed into the pancreatic duct to divert the pancreatic juice. The patient's abdominal pain improved immediately after pancreatic stent insertion, and amylase and lipase levels normalized within a week. Neoadjuvant chemotherapy was then initiated.
Using the fanning method in EUS-TS can inadvertently cause damage to the pancreatic duct and may lead to clinically significant pancreatitis. Placing a pancreatic stent may immediately resolve acute pancreatitis and shorten the waiting time for curative therapy. When using the fanning method during EUS-TS, ductal structures should be excluded to prevent pancreatic ductal leakage.
内镜超声引导下组织采样（EUS - TS）并发的胰管漏可表现为急性胰腺炎。
一名63岁男性因持续性腹痛和体重减轻就诊。诊断：实验室检查发现糖类抗原19 - 9（5920 U/mL）和癌胚抗原（23.7 ng/mL）水平升高。胰腺磁共振成像显示胰头下部有一个约3 cm边界不清的占位性病变，肠系膜上动脉严重受压。采用扇形法经EUS - TS获取的标本经病理检查确诊为胰腺导管腺癌。干预措施及结果：次日，患者出现严重腹痛，淀粉酶（265 U/L）和脂肪酶（1173 U/L）水平升高。腹部计算机断层扫描显示十二指肠第二部壁水肿增厚，伴有邻近液体积聚，胰头远端胆总管或主胰管有可疑漏出。内镜逆行胰胆管造影显示主胰管头部有造影剂渗漏。因此，在胰管内放置了一个5F 7 cm的线性塑料支架以引流胰液。放置胰管支架后患者腹痛立即改善，淀粉酶和脂肪酶水平在一周内恢复正常。随后开始新辅助化疗。
在EUS - TS中使用扇形法可能会无意中损伤胰管，并可能导致具有临床意义的胰腺炎。放置胰管支架可立即缓解急性胰腺炎并缩短进行根治性治疗的等待时间。在EUS - TS期间使用扇形法时，应避开导管结构以防止胰管漏出。
