Duggal Shivangini, Nagineni Lokesh, Trivedi Bhavi S, Zuckerman Marc, Badillo Ricardo
Texas Tech University Health Sciences Center El Paso, USA.
J Investig Med High Impact Case Rep. 2024 Jan-Dec;12:23247096241304521. doi: 10.1177/23247096241304521.
Imaging followed by endoscopic ultrasound (EUS)-guided therapy has become the preferred modality for treating pancreatic pseudocysts over surgical or radiological interventions. However, there continues to be a lack of consensus regarding the utility of endoscopic retrograde cholangiopancreatography (ERCP) before and after cyst drainage. We describe 4 cases of large pancreatic pseudocyst causing extrinsic biliary obstruction treated successfully with endoscopic cystogastrostomy decompression using a lumen-apposing self-expandable metal stent (LAMS) without ERCP. Endoscopic cystogastrostomy with LAMS was successful in all cases; none required ERCP. As endoscopic therapeutic systems continue to evolve, ERCP is becoming less essential to improve outcomes in patients with extrinsic biliary obstruction by pseudocysts and walled-off necrosis.
影像学检查后行内镜超声（EUS）引导下治疗已成为治疗胰腺假性囊肿优于手术或放射介入治疗的首选方式。然而，关于囊肿引流前后内镜逆行胰胆管造影（ERCP）的效用仍缺乏共识。我们描述了4例因巨大胰腺假性囊肿导致外在性胆管梗阻的病例，这些病例通过使用管腔贴靠自膨式金属支架（LAMS）行内镜下囊肿胃造口减压术成功治疗，未进行ERCP。所有病例行LAMS内镜下囊肿胃造口术均获成功；无一例需要ERCP。随着内镜治疗系统不断发展，对于因假性囊肿和包裹性坏死导致外在性胆管梗阻的患者，ERCP对于改善治疗效果已变得不那么必要。
