EUS-guided transgastric drainage of pancreaticopleural fistulas- single center experience
Notice bibliographique
Résumé
Aims Pancreaticopleural fistula (PPF) poses a rare and challenging complication of pancreatitis, leading to respiratory symptoms. With no established standard of management, endoscopy emerges as an alternative approach. However, challenges arise with transpapillary drainage during ERCP, particularly when inflammatory changes affect periampullary area. While endoscopic ultrasound (EUS) guided drainage presents a potential alternative, its efficacy and safety in this context have not been evaluated. This case report aims to assess efficacy and safety of EUS-guided transgastric drainage of PPF. Methods A prospective cohort study analyzed the outcomes of EUS-guided drainage in four patients with PPF. The study was carried out at the Department of General, Gastroenterological, and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, between 2021-2023. Results PPF was identified in four patients (all male; mean age 50.25 [42–61] years). Dyspnea was observed in all patients (100%), with one patient experiencing respiratory failure. 50% of patients presented with epigastric pain, and 75% exhibited fever. Organ failure occurred in two patients (25% each for kidney and liver), and sepsis was diagnosed in one patient (25%). CT revealed PPF communication with the left pleural cavity in 75% of patients and the right pleural cavity in 25%. Chronic pancreatitis was diagnosed in all patients. Despite unsuccessful transthoracic drainage in all cases, and failed transpapillary drainage during ERCP due to severe stenosis of the pancreatic duct (25%), inflammatory tumor of the pancreatic head (25%), and inflammatory periampullary infiltration (50%), EUS successfully visualized fistula tracts from the pancreatic body (50%), tail (25%), and neck (25%). The mean pleural collection size was 107.5 mm (80-150mm), with a mean distance of 18.75 mm (15-25mm) between the fistula tract and gastric wall, and a mean pancreatic duct size of 11.75 mm (10-15mm). In all patients (100%), EUS-guided transgastric drainage of the PPF was performed, with punctures of the fistulas’ tract from the gastric cardia (50%) and body (50%), followed by guidewire advancement and tract dilation using a 10Fr cystotome. Double pigtail stents (7Fr, 9-12cm) were placed in 3 of patients, and a lumen-apposing metal stent (30x16mm) in one. Technical and clinical success was achieved in all patients with no adverse events. The mean hospital stay was 7.75 days (5-12 days), and symptoms resolved in all patients. Stents were removed in two patients after 6 months, and during a mean follow-up period of 34 months (29-39 months), no recurrence was observed. Complete closure of fistula tracts with collection resorption was evident in CT. Two patients remained asymptomatic during follow-ups of 3 and 1 months, with stents in situ, and showed improvement in imaging. Conclusions In conclusion, EUS-guided transgastric drainage might be a safe and effective alternative for managing PPF refractory to conventional interventions. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».