Makazu Makomo, Koizumi Kazuya, Kubota Jun, Kimura Karen, Masuda Sakue
Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan.
World J Gastrointest Endosc. 2025 Sep 16;17(9):110424. doi: 10.4253/wjge.v17.i9.110424.
Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails. Endoscopic, percutaneous, and surgical drainage are options. Minimally invasive endoscopic procedures are generally considered the first-line treatment, with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case. Various dilators are used to dilate tracts to the leakage site. However, reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.
A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy. Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion. The effusion was diagnosed as reactive secondary to pancreatic fluid leakage. Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body. Distal to the stenosis, the main ductal structure was nearly obliterated by the tumor. The contrast medium had leaked into the pancreatic fluid leakage area through several fine, disrupted ductal structures. The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route. Standard dilators failed to expand the rigid trans-tumoral tract. A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract, enabling endoscopic nasopancreatic drainage tube placement. Subsequently, the pancreatic fluid leakage and pleural effusion resolved.
Even in rigid trans-tumoral tracts, the use of a drill dilator can facilitate successful tract expansion, enabling effective drainage.
胰液漏是胰腺癌的一种罕见并发症，保守治疗失败时通常需要引流。可选择内镜、经皮和手术引流。微创内镜手术一般被视为一线治疗方法，根据具体情况选择经乳头途径或内镜超声引导下经壁途径。使用各种扩张器扩张至漏液部位的通道。然而，关于使用钻孔扩张器通过硬质肿瘤内通道进行扩张的报道极为罕见。
一名74岁的胰体尾癌女性在多程化疗后出现发热和左侧胸痛。计算机断层扫描显示胰尾和脾脏周围有积液以及左侧胸腔积液。该积液被诊断为继发于胰液漏的反应性积液。内镜逆行胰胆管造影显示胰体部主胰管不规则狭窄。在狭窄远端，主胰管结构几乎被肿瘤完全阻塞。造影剂通过几条细小、破损的导管结构漏入胰液漏出区域。导丝成功通过一条极细的通道推进，该通道并非主要的造影剂充盈路径。标准扩张器未能扩张硬质肿瘤内通道。使用钻孔扩张器进行的第二次内镜逆行胰胆管造影成功扩张了肿瘤内通道，从而能够放置内镜鼻胰引流管。随后，胰液漏和胸腔积液得到缓解。
即使在硬质肿瘤内通道中，使用钻孔扩张器也可促进通道成功扩张，实现有效引流。
