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Acute and Chronic Pancreatitis, Pancreatic Malignancies

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 21843

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Special Issue Editors

Prof. Dr. Ẑilvinas Dambrauskas

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Guest Editor

Department of Surgery, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
Interests: laparoscopic surgery; trauma surgery; pancreatic surgery; tumors; cancer; surgical oncology; hepatobiliary surgery; surgical gastroenterology; colorectal surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Antanas Gulbinas

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Guest Editor

Department of Surgery, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania
Interests: chronic pancreatitis; pancreatic cancer; molecular mechanisms in carcinogenesis; mechanisms of chemoresistance in pancreatic cancer

Dr. Povilas Ignatavicius

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Guest Editor

Department of Surgery, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania
Interests: acute pancreatitis; pancreatic cancer; liver transplant; HPB surgery

Special Issue Information

Dear Colleagues,

Management of acute and chronic pancreatitis and complications of these diseases has rapidly evolved in recent years, however, there are still many clinically important questions to be addressed. Despite the progress in molecular and radiological diagnostics and the introduction of targeted therapies and introduction of minimally invasive techniques, the personalized treatment of patients presenting with cystic lesions, benign and malignant tumors of the pancreas is still a challenging and interesting field of medicine. Patients with pancreatic cancer are still waiting for the breakthrough in diagnostics and care leading to survival and quality of life comparable to that of patients with other malignant diseases.

This Special Issue aims to discuss the current trends in the diagnosis and management of pancreatic diseases, share the most recent findings from genetic, molecular and clinical studies of pancreatic diseases, including acute and chronic pancreatitis, cystic lesions and cancer of the pancreas.

We are looking for papers presenting cutting-edge research in molecular and clinical pancreatology, focusing on the molecular mechanisms of pancreatic diseases, novel approaches to the diagnosis, prognostication and treatment of acute and chronic pancreatitis, and pancreatic malignancies. Furthermore, we kindly invite you to share data about the novel methods of interventional, minimally invasive and surgical management of benign and malignant pancreatic diseases.

Prof. Dr. Žilvinas Dambrauskas
Dr. Antanas Gulbinas
Dr. Povilas Ignatavicius
Guest Editors

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Keywords

acute pancreatitis
chronic pancreatitis
benign tumors of the pancreas
pancreatic cystic lesions
pancreatic cancer
cancer immunity
molecular mechanisms of carcinogenesis and drug resistance
pancreatic surgery
minimally invasive surgery

Published Papers (11 papers)

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Editorial

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3 pages, 234 KiB

Open AccessEditorial

Editorial for the Special Issue “Acute and Chronic Pancreatitis, Pancreatic Malignancies”

by Antanas Gulbinas, Povilas Ignatavicius and Zilvinas Dambrauskas

Medicina 2023, 59(5), 984; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59050984 - 19 May 2023

Cited by 2 | Viewed by 1110

Abstract

Pancreatic diseases, especially acute pancreatitis and pancreatic cancer, are associated with high rates of complications, difficult treatment that may not always be effective, and high mortality in complex cases [...] Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

Research

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12 pages, 1540 KiB

Open AccessArticle

Clinical Outcomes of the Endoscopic Step-Up Approach with or without Radiology-Guided Percutaneous Drainage for Symptomatic Walled-Off Pancreatic Necrosis

by Tanawat Pattarapuntakul, Tummarong Charoenrit, Thanawin Wong, Nisa Netinatsunton, Bancha Ovartlarnporn, Thanapon Yaowmaneerat, Teeravut Tubtawee, Pattira Boonsri and Pimsiri Sripongpun

Medicina 2023, 59(3), 569; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59030569 - 14 Mar 2023

Cited by 3 | Viewed by 1347

Abstract

Background and objectives: Symptomatic walled-off pancreatic necrosis is a serious local complication of acute necrotising pancreatitis. The endoscopic step-up approach is the standard treatment for symptomatic walled-off pancreatic necrosis; however, adjunctive radiologic percutaneous drainage for this condition is controversial. This study compared the clinical and radiologic resolution of walled-off pancreatic necrosis achieved with the endoscopic step-up approach with or without radiology-guided percutaneous drainage. Material and Methods: This retrospective, single-centre cohort study enrolled patients with symptomatic walled-off pancreatic necrosis who underwent endoscopic transmural drainage (ETD) followed by directed endoscopic necrosectomy (DEN) with or without radiology-guided drainage. A total of 34 patients (endoscopic approach, n = 22; combined modality approach, n = 12) underwent the endoscopic step-up approach (ETD followed by DEN). Baseline characteristics, clinical success, and resolution of necrosis were compared between groups. Results: All patients achieved symptom resolution from walled-off pancreatic necrosis. The mean patient age was 58.4 years, and 21 (61.8%) were men. Following treatment with the endoscopic approach and combined modality approach, clinical success was achieved in 90.9% of patients within 11.5 days, and 66.7% of patients within 16.5 days, respectively. Both length of hospital stay (55 days vs. 71 days; p = 0.071) and time to complete radiologic resolution were shorter (93 days vs. 124 days; p = 0.23) in the endoscopic approach group. Conclusion: Both the endoscopic step-up approach and the CMD approach resulted in a favourably high clinical resolution rates in patients with symptomatic WON. However, clinical success rates seemed to be higher, and the length of hospital stay tended to be shorter in the endoscopic approach than in the CMD approach, as well as the significantly shorter necrosectomy time in each procedure was observed. Of note, these findings might be from some inherited differences in baseline characteristics of the patients between the two groups, and a randomized controlled trial with a larger sample size to verify these results is warranted. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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13 pages, 19806 KiB

Open AccessArticle

Dynamic Changes in Serum Cytokine Profile in Rats with Severe Acute Pancreatitis

by Rui Zhou, Wangjun Bu, Yudan Fan, Ziwei Du, Jian Zhang, Shu Zhang, Jin Sun, Zongfang Li and Jun Li

Medicina 2023, 59(2), 321; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59020321 - 09 Feb 2023

Cited by 2 | Viewed by 1491

Abstract

Background and Objectives: Most published research has only investigated a single timepoint after the onset of severe acute pancreatitis (SAP), meaning that they have been unable to observe the relationship between the dynamic changes in cytokines and SAP progression. In this study, we attempted to reveal the relationship between dynamic changes in cytokine expression levels and SAP disease progression and the relationship between cytokines, using continuous large-scale cytokine detection. Materials and Methods: Seventy rats were randomly assigned to control (Con), sham operation (SO) and SAP groups. The SAP group was randomly allocated to five subgroups at 3, 6, 9, 12 and 15 h after the operation. In the SAP group, 5% sodium taurocholate was injected retrograde into the pancreatic bile duct. Animals in the SO group received a similar incision, a turning over of the pancreas. Control animals did not receive any treatment. We observed the survival, ascites fluid amount, pancreatic histopathological scores and serum amylase activity of SAP rats. We used the cytokine microarray to simultaneously detect 90 cytokines and the dynamic changes in one experiment and to analyze the correlation between cytokine expression and disease progression. Results: The mortality of SAP rats increased with an increase in time. Serum amylase activity, pancreatic histopathological scores and ascites fluid amount were time-dependent. Compared with normal rats, 69 cytokines in SAP rats were significantly changed for at least one timepoint, and 49 cytokines were significantly changed at different timepoints after SAP induction. The changes in inflammatory cytokines were significantly upregulated at 6 and 9 h and 12 h and then significantly decreased. Conclusions: The trend of cytokine expression in SAP rats was not consistent with the disease progression. The cytokine–cytokine receptor interaction and MAPK signal’s dominant cytokines were always highly expressed at various time points over the course of SAP. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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15 pages, 2343 KiB

Open AccessArticle

Pancreatic Cystic Tumors: A Single-Center Observational Study

by Beata Jabłońska, Arkadiusz Gudz, Tomasz Hinborch, Bartosz Bujała, Katarzyna Biskup and Sławomir Mrowiec

Medicina 2023, 59(2), 241; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59020241 - 27 Jan 2023

Cited by 2 | Viewed by 1788

Abstract

Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and Methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014–2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n = 124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40–79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22–55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6–10 cm) and the mean size of MCNs was the largest 6.78 (1.5–19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient’s age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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8 pages, 305 KiB

Open AccessArticle

Controlling Nutritional Status (CONUT) Score and Prognostic Nutritional Index (PNI) Are Good Candidates for Prognostic Markers for Acute Pancreatitis

by Mustafa Zanyar Akkuzu, Engin Altıntaş, Serkan Yaraş, Orhan Sezgin, Fehmi Ateş, Enver Üçbilek and Osman Özdoğan

Medicina 2023, 59(1), 70; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59010070 - 28 Dec 2022

Cited by 7 | Viewed by 1732

Abstract

Background and Objectives: It has been demonstrated that parameters such as the Controlled Nutrition Status (CONUT) score and Prognostic Nutrition Index (PNI) are beneficial for the assessment of patients’ nutrition. In this study, our objective was to investigate the potential benefits of CONUT and, as a prognostic marker of acute pancreatitis, the PNI. Materials and Methods: The data of 361 patients were analysed retrospectively. The PNI and CONUT scores of these patients were retrospectively calculated. They were categorised as CONUT-high (≥3) and CONUT-low (≤2). A PNI ≥ 45 was considered high and a PNI < 45 low. The AP severity and organ failure due to disease were evaluated based on Atlanta 2012. Results: According to the CONUT score, it was found that 209 patients had normal to mild, whereas 152 patients had severe malnutrition. A total of 293 patients had mild AP and 68 thereof had severe AP. The patients with a high CONUT score used more antibiotics, were hospitalised more in intensive care units and experienced organ failure more frequently. There were no intensive care hospitalisations, mortalities, surgical needs and local complications among the patients with a higher PNI score. Conclusions: CONUT and the PNI have proven to be useful prognostic markers not only for predicting nutritional status but also for estimating the severity and results of AP. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

10 pages, 853 KiB

Open AccessArticle

Fibrinogen-like Protein 1 as a Predictive Marker for the Incidence of Severe Acute Pancreatitis and Infectious Pancreatic Necrosis

by Yuhang Sui, Zhongjie Zhao, Yang Zhang, Tao Zhang, Guanqun Li, Liwei Liu, Hongtao Tan, Bei Sun and Le Li

Medicina 2022, 58(12), 1753; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58121753 - 29 Nov 2022

Cited by 5 | Viewed by 1410

Abstract

Background and Objectives: Acute pancreatitis (AP) is defined as an acute inflammatory disorder of the pancreas and is a common gastrointestinal disease. Since currently used indicators lack specifics and cannot accurately reflect the phase of disease, better diagnostic approaches need to be explored. Fibrinogen-like protein 1 (FGL-1) is a reactant in acute inflammatory diseases and is increased in the plasma of AP patients. In the current study, we aim to investigate the clinical benefits of FGL-1 in predicting the severity of AP and infected pancreatic necrosis (IPN), which can improve the diagnostic efficiency of AP. Materials and Methods: In this study, 63 patients diagnosed with AP from December 2018 to September 2019 were enrolled. Regarding the severity of AP, patients were separated into severe acute pancreatitis (SAP, n = 12) and No-SAP groups (n = 51). On the basis of infective conditions, patients were divided into IPN (n = 9) and No-IPN (n = 54) groups. The demographic data (sex and age) and blood parameters (WBC, HCT, glucose, calcium, FIB, APTT, PCT, CRP, and FGL-1) were retrospectively analyzed. Results: The plasma FGL-1 levels were increased in both SAP (p < 0.01) and IPN (p < 0.05) subgroups compared to the healthy control group. Multivariate analysis showed that elevated plasma FGL-1 (p < 0.01) and PCT levels (p < 0.05) within 72 h after the onset of AP were positively correlated with the severity of AP, while increased plasma FGL-1 (p < 0.01) and CRP (p < 0.05) levels were positively correlated with the occurrence of IPN. The combination of FGL-1 and PCT showed superiority to both individual markers in SAP prediction. However, the combination of FGL-1 and CRP showed no diagnostic advantage over CRP in IPN prediction. Conclusions: Plasma FGL-1 within 72 h after the onset could be used for the stratification of AP and its infectious complications. The combination of PCT and FGL-1 presents an enormous advantage for the early identification of SAP. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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8 pages, 273 KiB

Open AccessArticle

Volume, but Not the Location of Necrosis, Is Associated with Worse Outcomes in Acute Pancreatitis: A Prospective Study

by Inga Dekeryte, Kristina Zviniene, Edita Bieliuniene, Zilvinas Dambrauskas and Povilas Ignatavicius

Medicina 2022, 58(5), 645; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58050645 - 08 May 2022

Cited by 4 | Viewed by 1596

Abstract

Background and Objectives: The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods: A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (<30%, 30–50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results: The study included 83 patients (75.9% males (n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients (n = 42, 51%). Positive blood culture (n = 14 (87.5%)), multiple organ dysfunction syndrome (n = 17 (73.9%)) and incidences of respiratory failure (n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p < 0.05). Patients with >50% of necrosis were significantly (p < 0.05) more often diagnosed with moderately severe (n = 24 (41.4%)) and severe (n = 18 (72%)) AP. The number of surgical interventions (n = 18 (72%)) and ultrasound-guided interventions (n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency (n = 11 (64.7%)) and infected pancreatic necrosis (n = 19 (57.6%)) was significantly higher (p < 0.05). Conclusions: The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

Review

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11 pages, 658 KiB

Open AccessReview

Postoperative Hypophosphatemia as a Prognostic Factor for Postoperative Pancreatic Fistula: A Systematic Review

by Ieva Grikyte and Povilas Ignatavicius

Medicina 2023, 59(2), 274; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59020274 - 31 Jan 2023

Cited by 3 | Viewed by 1682

Abstract

Background and Objectives: Postoperative pancreatic fistula (POPF) is one of the most challenging complications after pancreatic resections, associated with prolonged hospital stay and high mortality. Early identification of pancreatic fistula is necessary for the treatment to be effective. Several prognostic factors have been identified, although it is unclear which one is the most crucial. Some studies show that post-pancreatectomy hypophosphatemia may be associated with the development of POPF. The aim of this systematic review was to determine whether postoperative hypophosphatemia can be used as a prognostic factor for postoperative pancreatic fistula. Materials and Methods: The systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). The PubMed, ScienceDirect, and Web of Science databases were systematically searched up to the 31st of January 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for POPF. Data including study characteristics, patient characteristics, operation type, definitions of postoperative hypophosphatemia and postoperative pancreatic fistula were extracted. Results: Initially, 149 articles were retrieved. After screening and final assessment, 3 retrospective studies with 2893 patients were included in this review. An association between postoperative hypophosphatemia and POPF was found in all included studies. Patients undergoing distal pancreatectomy were more likely to develop severe hypophosphatemia compared to patients undergoing proximal pancreatectomy. Serum phosphate levels on postoperative day 4 (POD 4) and postoperative day 5 (POD 5) remained significantly lower in patients who developed leak-related complications showing a slower recovery of hypophosphatemia from postoperative day 3 (POD 3) through postoperative day 7 (POD 7). Moreover, body mass index (BMI) higher than 30 kg/m², soft pancreatic tissue, abnormal white blood cell count on postoperative day 3 (POD 3), and shorter surgery time were associated with leak-related complications (LRC) and lower phosphate levels. Conclusions: Early postoperative hypophosphatemia might be used as a prognostic biomarker for early identification of postoperative pancreatic fistula. However, more studies are needed to better identify significant cut-off levels of postoperative hypophosphatemia and development of hypophosphatemia in the postoperative period. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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21 pages, 816 KiB

Open AccessReview

Modifiable and Non-Modifiable Risk Factors for the Development of Non-Hereditary Pancreatic Cancer

by Marek Olakowski and Łukasz Bułdak

Medicina 2022, 58(8), 978; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58080978 - 22 Jul 2022

Cited by 9 | Viewed by 4767

Abstract

Pancreatic cancer is becoming an increasing healthcare concern. Though it is a 14th most common cancer worldwide, its incidence is steadily rising. Results of currently available therapies are still not satisfactory. Therefore, great attention should be put on the identification and reduction of risk factors for pancreatic cancer. A thorough up-to-date review of available data on the impact of well-established and novel risk factors of pancreatic cancer development have been performed. Several risk factors associated with lifestyle have significant impact on the risk of pancreatic cancer (i.e., smoking, obesity, alcohol consumption). Physicians should also be aware of the novel findings suggesting increasing role of microbiome, including viral and bacterial infections, in the development of pancreatic cancer. A growing body of evidence suggest also an increased risk during certain occupational exposures. In general, lifestyle seems to be a major contributor in the development of pancreatic cancer. Special attention should be given to individuals with a vicious cluster consisting of metabolic syndrome, tobacco smoking and alcohol consumption. Physicians should urge patients to comply to healthy diet, cessation of smoking and moderation of alcohol consumption, which may halve pancreatic cancer incidence. Further studies are warranted to explore the potential use of therapeutic approach on novel risk factors (e.g., microbiome). Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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12 pages, 572 KiB

Open AccessReview

Interdisciplinary Approach of Establishing PDAC Resectability: Biochemical, Radiological and NAT Regimen Prognostic Factors—Literature Review

by Aiste Gulla, Daisuke Hashimoto, Doris Wagner, Ryte Damaseviciute, Kestutis Strupas and Sohei Satoi

Medicina 2022, 58(6), 756; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58060756 - 01 Jun 2022

Cited by 5 | Viewed by 1871

Abstract

Background and Objectives: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal tumors, with a 5-year overall survival rate of less than 10%. To date, curative surgical resection remains the only favorable option for improving patients’ survival. However, there is no consensus on which prognostic biochemical, radiological markers or neoadjuvant therapy regimens would benefit patients the most. Materials and Methods: A literature review was performed focusing on overall survival, R0 resection, 30-day mortality, adverse events (AEs), and elevated biomarkers. The electronic databases were searched from 2015 to 2020. Results: We reviewed 22 independent studies. In total, 20 studies were retrospective single- or multi-center reviews, while 2 studies were prospective Phase II trials. Conclusions: Patients with borderline resectable or locally advanced PDAC, who received neoadjuvant therapy (NAT) and surgery, have significantly better survival rates. The CA 19-9 biomarker levels in the neoadjuvant setting should be evaluated and considered as a specific biomarker for tumor resectability and overall survival. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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Other

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9 pages, 3047 KiB

Open AccessCase Report

Clinical Outcomes of EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series

by Bozhidar Hristov, Deyan Radev, Petar Uchikov, Gancho Kostov, Mladen Doykov, Siyana Valova and Eduard Tilkiyan

Medicina 2023, 59(2), 351; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59020351 - 13 Feb 2023

Cited by 3 | Viewed by 1983

Abstract

Introduction. Pancreatic ductal adenocarcinoma (PDA) is associated with poor prognosis and 98% loss-of-life expectancy. 80% of patients with PDA are unfit for radical surgery. In those cases, emphasis is set on management of cancer-related symptoms, among which obstructive jaundice is most common. Endoscopic ultrasound-guided biliary drainage (EUS-BD) emerges as a valid alternative to the well-accepted methods for treatment of biliary obstruction. Patient Selection. Five consecutive patients with unresectable pancreatic malignancy, were subjected to EUS-BD, particularly EUS-guided choledochoduodenostomy (EUS-CDS). Ethics. Oral and written informed consent was obtained in all cases prior procedure. Technique. EUS-guided puncture of the common bile duct was performed, followed by advancement of a guidewire to the intrahepatic bile ducts. After dilation of the fistulous tract with a cystotome, a fully covered self-expandable metal stent was inserted below the hepatic confluence and extending at least 3 cm in the duodenum. Technical and clinical success was achieved in four patients without adverse events. In one patient procedure failed due to dislocation of the guidewire, with consequent biliary leakage requiring urgent surgery. Recovery was uneventful with no further clinical sequelae and there was no mortality associated with procedure. Discussion. Introduced in 2001, EUS-guided biliary drainage has become an accepted option for treatment of obstructive jaundice. According to recent guidelines published by European Society of Gastrointestinal Endoscopy (ESGE) in 2022, EUS-CDS is a preferred modality to percutaneous transhepatic biliary drainage (PTBD) and surgery in patients with failed ERCP, with comparable efficiency and better safety profile, which is supported by our experience with the procedure. Conclusions. Our case series suggests that EUS-CDS is an excellent option for palliative management of malignant distal biliary obstruction, emphasizes on the importance of adequate technique and experience for the technical success, and urges the need for future research on establishing the best choice for guidewire and dilation device. Full article

(This article belongs to the Special Issue Acute and Chronic Pancreatitis, Pancreatic Malignancies)

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