EUS-guided transgastric drainage of pancreaticopleural fistulas- single center experience
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".