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1.
Gastrointest Endosc ; 2024 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-39053654

RESUMO

BACKGROUND AND AIMS: Pancreatic fluid collections (PFC) may recur after initial successful endoscopic drainage of walled-off necrosis (WON), most commonly due to disconnected pancreatic duct syndrome (DPDS). The primary aim of this study is to assess the role of magnetic resonance cholangiopancreatography (MRCP) for identifying DPDS to guide appropriate management and prevent PFC recurrence. METHODS: Patients with WON undergoing LAMS drainage of a PFC were retrospectively identified and categorized as those with versus those without MRCP prior to removal of transmural stents. Data on patient demographics, procedural details, cross-sectional imaging, and recurrence rates were collected through chart review. RESULTS: A total of 121 patients with WON were identified, of whom 44 (36.4%) had an MRCP prior to transmural stent removal. In patients without MRCP, 13/77 (16.8%) had PFC recurrence versus 0/44 (0%; p=0.003) in those with MRCP. MRCP identified DPDS in 12 (27.2%) patients, all of whom were managed with indefinite drainage with double-pigtail plastic stents (DPPS) without recurrence. In the group without MRCP, PFCs recurred at a median interval of 284 days (IQR 182-618 days) after transmural stent removal. Among the 13 patients with PFC recurrence, 11 patients (85%) had undiagnosed DPDS detected on subsequent imaging, of whom 9 were subsequently managed with indefinite DPPS, without further PFC recurrence. CONCLUSION: Patients with WON who underwent MRCP prior to transmural stent removal had a lower rate of PFC recurrence largely due to the identification of DPD with appropriate endoscopic management.

2.
Dig Dis Sci ; 68(11): 4259-4265, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37665426

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) within 72 h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24 h) improved outcomes compared to early ERCP (24-72 h) in patients admitted with predicted mild ABP. METHODS: Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72 h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs). RESULTS: Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6 mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3 days (IQR 3-4), p < 0.01]. CONCLUSION: Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission.

3.
VideoGIE ; 8(1): 23-26, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36644251

RESUMO

Video 1Endoscopic approach for management of dropped gallstones using percutaneous cholangioscopy.

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