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DOI: 10.1055/s-2003-36413
Therapeutic Pancreatic Endoscopy
Publication History
Publication Date:
02 January 2003 (online)
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The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of pancreatic diseases is continuing to evolve. This article reviews recent publications spanning a wide range of topics related to therapeutic pancreatic endoscopy: Over the last 12 months, several case series have added to the literature on the short-term and long-term effectiveness of endoscopic therapy of pseudocysts, pancreatic abscesses and fistulas. Identification of a communication between pancreatic duct and a pseudocyst has been suggested to predict response to percutaneous drainage. The importance of identifying pancreatic leaks in patients with severe pancreatitis has been stressed. In addition, endotherapy has been reported to be effective in patients with idiopathic chronic pancreatitis. Endoscopic removal of pancreatic stones after extracorporeal lithotripsy has been shown to result in long-term improvement in clinical outcomes in patients with chronic calcific pancreatitis. Other interesting publications addressed new techniques and tricks to achieve access to the difficult pancreatic duct. Finally, no review of pancreatic endotherapy would be complete without a reminder - as recently stated by a National Institutes of Health consensus panel - that there is considerable need for higher-quality and controlled trials in this and other areas of interventional endoscopy.
References
- 1 Baron T H, Fleischer D E. Past, present, and future of endoscopic retrograde cholangiopancreatography: perspectives on the National Institutes of Health consensus conference. Mayo Clin Proc. 2002; 77 407-412
- 2 Aizawa T, Ueno N. Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones. Gastrointest Endosc. 2001; 54 209-213
- 3 Lau S T, Simchuk E J, Kozarek R A, Traverso L W. A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg. 2001; 181 411-415
- 4 Park J J, Kim S S, Koo Y S. et al . Definitive treatment of pancreatic abscess by endoscopic transmural drainage. Gastrointest Endosc. 2002; 55 256-262
- 5 Sharma S S, Bhargawa N, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up. Endoscopy. 2002; 34 203-207
- 6 Nealon W H, Walser E. Main pancreatic ductal anatomy can direct choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage). Ann Surg. 2002; 235 751-758
- 7 Costamagna G, Mutignani M, Ingrosso M. et al . Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy. 2001; 33 317-322
- 8 Canty T G, Weinman D. Management of major pancreatic duct injuries in children. J Trauma. 2001; 50 1001-1007
- 9 Canty T G, Weinman D. Treatment of pancreatic duct disruption in children by an endoscopically placed stent. J Pediatr Surg. 2001; 36 345-348
- 10 Kim H S, Lee D K, Kim I W. et al . The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc. 2001; 54 49-55
- 11 Cohen S A, Siegel J H. Pancreas divisum: endoscopic therapy. Surg Clin North Am. 2001; 81 467-477
- 12 Heyries L, Barthet M, Delvasto C. et al . Long-term results of endoscopic management of pancreas divisum with recurrent acute pancreatitis. Gastrointest Endosc. 2002; 55 376-381
- 13 Kim M H, Lee S S, Kim C D. et al . Incomplete pancreas divisum: is it merely a normal anatomic variant without clinical implications?. Endoscopy. 2001; 33 778-785
- 14 Gabbrielli A, Mutignani M, Pandolfi M. et al . Endotherapy of early onset idiopathic chronic pancreatitis: results with long-term follow-up. Gastrointest Endosc. 2002; 55 488-493
- 15 Jacob L, Geenen J E, Catalano M F, Geenen D J. Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents. Endoscopy. 2001; 33 559-562
- 16 Kozarek R A, Brandabur J J, Ball T J. et al . Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc. 2002; 56 496-500
- 17 Wallace M B, Hawes R H. Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis. Pancreas. 2001; 23 26-35
- 18 Fogel E L, Eversman D, Jamidar P, Sherman S, Lehman G A. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002; 34 280-285
- 19 Bataille L, Deprez P. A new application for therapeutic EUS: main pancreatic duct drainage with a pancreatic rendezvous technique. Gastrointest Endosc. 2002; 55 740-743
- 20 Freeman M L, Cass O W, Dailey J. Dilation of high-grade pancreatic and biliary ductal strictures with small-caliber angioplasty balloons. Gastrointest Endosc. 2001; 54 89-92
- 21 Bown S G, Rogowska A Z, Whitelaw D E. et al . Photodynamic therapy for cancer of the pancreas. Gut. 2002; 50 549-557
- 22 Pugliese V, Pujic N, Saccomanno S. et al . Pancreatic intraductal sampling during ERCP in patients with chronic pancreatitis and pancreatic cancer: cytologic studies and k-ras-2 codon 12 molecular analysis in 47 cases. Gastrointest Endosc. 2001; 54 595-599
- 23 Hurwitz L K, Daniels A, Barkin J S. et al . Preoperative diagnosis of intraductal papillary mucinous tumors of the pancreas by endoscopic pancreatic biopsy. Gastrointest Endosc. 2001; 53 510-513
- 24 Hara T, Yamaguchi T, Ishihara T. et al . Diagnosis and patient management of intraductal papillary mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology. 2002; 122 34-43
- 25 Desilets D J, Dy R M, Ku P M. et al . Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc. 2001; 54 202-208
R. A. Kozarek, M.D.
Section Head, Section of Gastroenterology · Virginia Mason Medical Center ·
1100 Ninth Avenue · PO Box 900 (C3-GAS) · Seattle, WA 98101 · USA ·
Fax: + 1-206-223-6379
Email: gasrak@vmmc.org