Establishment of a risk prediction model for pancreatic fistula after pancreaticoduodenectomy： A study based on the 2016 edition of the definition and classification system of pancreatic fistula / 临床肝胆病杂志

ObjectiveTo investigate the differences in the risk factors for postoperative pancreatic fistula （POPF） after pancreaticoduodenectomy （PD） between the 2005 and 2016 editions of the definition and classification standards for pancreatic fistula， and to establish a risk prediction model for pancreatic fistula based on the 2016 edition. MethodsA retrospective analysis was performed for the clinical data of 303 patients who were admitted to Tianjin Third Central Hospital and underwent PD from January 2016 to May 2022， and the patients with POPF were identified based on the new and old editions. The independent-samples t test or the non-parametric Mann-Whitney U test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the differences in the risk factors for pancreatic fistula after PD between the two editions； a risk prediction model was established for POPF based on the 2016 edition， and the receiver operating characteristic curve was used to invesitgate the accuracy of this model in predicting POPF and perform model validation. ResultsAccording to the 2005 edition， the univariate analysis showed that the diameter of the main pancreatic duct （χ2=31.641， P<0.001）， main pancreatic duct index （χ2=52.777， P<0.001）， portal vein invasion （χ2=6.259， P=0.012）， intra-abdominal fat thickness （χ2=7.665， P=0.006）， preoperative biliary drainage （χ2=5.999， P=0.014）， pancreatic cancer （χ2=5.544， P=0.019）， marginal pancreatic thickness （t=2.055， P=0.032）， pancreatic CT value （t=-3.224， P=0.002）， and preoperative blood amylase level （Z=-2.099， P=0.036） were closely associated with POPF， and the multivariate logistic regression analysis showed that main pancreatic duct index （odds ratio ［OR］=0.000， 95% confidence interval ［CI］： 0.000‍ ‍—‍ ‍0.011， P<0.05）， pancreatic cancer （OR=4.843， 95%CI： 1.285‍ ‍—‍ ‍18.254， P<0.05）， and pancreatic CT value （OR=0.869， 95%CI： 0.806‍ ‍—‍ ‍0.937， P<0.05） were independent risk factors； based on the 2016 edition， the univariate analysis showed the diameter of the main pancreatic duct （χ2=5.391， P=0.020）， main pancreatic duct index （χ2=11.394， P=0.001）， intra-abdominal fat thickness （χ2=8.899， P=0.003）， marginal pancreatic thickness （t=2.665， P=0.009）， pancreatic CT value （t=-2.835， P=0.004） were closely associated with POPF， and the multivariate logistic regression analysis showed that main pancreatic duct index （OR=0.001， 95%CI： 0.000‍ ‍—‍ ‍0.050， P<0.05） and pancreatic CT value （OR=0.943， 95%CI： 0.894‍ ‍—‍ ‍0.994， P<0.05） were independent risk factors. A risk prediction model was established for POPF after PD， and the ROC curve analysis showed that this model had an area under the ROC curve of 0.788 （95%CI： 0.707‍ ‍—‍ ‍0.870） in the modeling group and 0.804 （95%CI： 0.675‍ ‍—‍ ‍0.932） in the validation group. ConclusionMain pancreatic duct index and pancreatic CT value are closely associated with POPF after PD， and the risk prediction model for pancreatic fistula based on the 2016 edition has a good prediction accuracy.

Pancreatoscopia: aplicaciones y recomendaciones / Pancreatoscopy: applications and recommendations

Pancreatoscopy is an advanced endoscopic technique that allows direct observation of the main pancreatic duct, facilitating both diagnosis and treatment of various pancreatic conditions. It enables biopsies and assessment of lesion malignancy. This procedure is performed under deep sedation or anesthesia, with non-steroidal anti- inflammatory drugs recommended for prophylaxis. It is primarily used in diagnosing pancreatic duct strictures and intraductal papillary mucinous neoplasms. Within treatment, its utility is highlighted in intraductal lithotripsy, especially in cases of chronic pancreatitis. The most common adverse effect is acute post-procedural pancreatitis, though estimated in less than 5% of cases. Proper technique, saline administration control, and placement of stents at the end of procedure help minimize complications. Despite being reserved as second-line therapy for pancreatic lithiasis, it offers several advantages over traditional techniques, and it is anticipated that with some advancements in the future, it will become a first-line therapeutic option.

La pancreatoscopia es una técnica endoscópica que permite la observación directa del conducto pancreático prin- cipal, facilitando tanto el diagnóstico como el tratamiento de diversas afecciones pancreáticas. Permite realizar biopsias y evaluar la malignidad de las lesiones. Este procedimiento se realiza bajo sedación profunda o anestesia, y se recomienda la administración de antiinflamatorios no esteroidales en forma de profilaxis. Se utiliza princi- palmente en el diagnóstico de estenosis del conducto pancreático y neoplasias mucinosas papilares intraductales. En el tratamiento, se destaca su utilidad en la litotricia intraductal, especialmente en casos de pancreatitis crónica. El efecto adverso más común es la pancreatitis aguda posprocedimental, aunque se estima en menos del 5% de los casos. Una adecuada técnica, control del suero y la colocación de prótesis al final del procedimiento ayudan a minimizar las complicaciones. A pesar de reservarse como segunda línea en el tratamiento de litiasis pancreáti- cas, presenta diversas ventajas sobre técnicas tradicionales, y se espera que con algunos avances en un futuro se convierta en una opción de primera línea terapéutica.

Classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy / 国际外科学杂志

Objective:To investigate the classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy (LPD).Methods:The records of 51 consecutive patients with LPD who were treated by linear staple closure technique of pancreatic neck from February to December 2022 from Binzhou Second People′s Hospital, Shijingshan Campus, Beijing Chaoyang Hospital, Capital Medical University, Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute, Chaoyang Central Hospital, Shandong Juxian People′s Hospital, Weihai Municipal Hospital, Binzhou Central Hospital, and Affiliated Hospital of Chifeng University were retrospectively reviewed. According to the visibility, position and diameter of the main pancreatic duct at the stump of the pancreas, the type of main pancreatic duct was divided into type I, type Ⅱ, type Ⅲa and type Ⅲb. The number of cases in each main pancreatic duct classification and the corresponding treatment strategies were examined.Results:A total of 51 cases of LPD were successfully completed. Of these patients, the males comprised 56.9%(29/51), and females comprised 43.1%(22/51), with age ranging from 31 to 88 years old. The type of the main pancreatic duct at the stump of the pancreas included 7 cases (13.7%) of type Ⅰ, 39 cases (76.5%) of type Ⅱ, 2 cases (3.9%) of type Ⅲa, and 3 cases (5.9%) of type Ⅲb. Corresponding treatment strategies were adopted according to different main pancreatic duct types, the main pancreatic duct was successfully found, and a support drainage tube was inserted.Conclusion:After linear stapler closure of pancreatic neck, corresponding treatment strategies should be adopted according to the classification of the main pancreatic duct, which would help to improve the success rate of finding the main pancreatic duct and placing a support drainage tube.

Progress in the diagnosis and treatment of pancreatic duct stones / 中华肝胆外科杂志

Pancreatic duct stones are one of the benign pancreatic diseases. It is often combined with chronic pancreatitis. The disease will progress to pancreatic cancer without timely treatment, thus reducing the quality of life of patients and seriously affecting their physical and psychological health. In recent years, with the development of imaging technology, the detection rate of pancreatic duct stones has been increasing year by year. This article reviewed the etiology, diagnosis and treatment strategies for pancreatic duct stones in recent years.

Application of laser lithotripsy under SpyGlass in difficult pancreatic duct stones (with video) / 中华消化内镜杂志

To evaluate the application of laser lithotripsy under SpyGlass for difficult pancreatic duct stones. Data of patients who underwent laser lithotripsy under SpyGlass for difficult pancreatic duct stones from January 2018 to April 2020 in Shandong Provincial Third Hospital were collected. A total of 18 patients were included in the study and the number of endoscopic retrograde cholangiopancreatography (ERCP) performed on each patient was 1.5±0.7. The total operation success rate was 88.9% (16/18) and the number of SpyGlass lithotripsy was 1.3±0.4. The diameter of the stones was 13.17±3.69 mm and the number of stones was 1.70±0.74. Nine patients had stones located in the pancreatic head and 15 cases had stenosis of the proximal pancreatic duct. One case had post-ERCP pancreatitis. No bleeding, perforation or other complications occurred. The indwelling time of the pancreatic duct stent was 10.5±2.8 months, and the follow-up was 6-30 months. There was no recurrence of pancreatic duct stenosis or pancreatic duct stones. Laser lithotripsy under SpyGlass is safe and effective for difficult pancreatic duct stones.

A preliminary study of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis / 中华消化内镜杂志

To study the preventive effects of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Patients receiving ERCP were divided into the treatment group and the control group by random number table. In the treatment group, double guidewire technique combined with pancreatic duct stenting was applied. In the control group, selective biliary intubation was applied in the conventional way. The intubation time, PEP, hyperamylasemia and bleeding incidence were analyzed between the two groups. A total of 80 patients were enrolled in this study from January 2016 to December 2018. There were 40 cases in the treatment group and 39 cases in the control group. In the treatment group, the mean intubation time was 384±102 seconds. No PEP or bleeding during and after the operation occurred, but hyperamylasemia occurred in 2 cases. In the control group, the mean intubation time was 427±115 seconds. Hyperamylasemia occurred in 6 cases, PEP occurred in 3 cases, and 1 case of intraoperative bleeding happened in the control group. The incidence of PEP [0 VS 7.7%(3/39)]and hyperamylasemia [5.0% (2/40)VS 15.4%(6/39)] were lower in the treatment group (both P<0.05). Double guidewire technique combined with pancreatic duct stenting can successfully perform selective bile duct intubation and effectively prevent PEP.

Ansa pancreática: desafio no diagnóstico etiológico em paciente jovem com pancreatite grave / Ansa pancreatica: etiological diagnosis challenge in a young patient with severe pancreatitis

A ansa pancreática é uma variação anatômica rara dos ductos pancreáticos. Consiste numa comunicação entre o ducto pancreático principal (Wirsung) e o ducto pancreático acessório (Santorini). Recentemente, estudos têm demonstrado estar essa variação anatômica implicada como fator predisponente e significativamente associada a episódios recorrentes de pancreatite aguda. A pancreatite é uma entidade clínica pouco frequente na infância. Diferente dos adultos, as causas mais comuns incluem infecções virais, por ascaris, medicamentosas, traumas e anomalias estruturais. O objetivo deste estudo foi relatar um caso de pancreatite aguda grave não alcoólica e não biliar, em um paciente jovem de 15 anos, em cuja propedêutica imagenológica evidenciou-se alça, comunicando com os ductos pancreáticos ventral e dorsal, compatível com ansa pancreática.

Ansa pancreatica is a rare anatomical variation of the pancreatic ducts. It consists of communication between the main pancreatic duct (Wirsung) and the accessory pancreatic duct (Santorini). Recently, studies have shown that this anatomical variation is implicated as a predisposing factor and significantly associated with recurrent episodes of acute pancreatitis. Pancreatitis is a rare clinical entity in childhood. Different from that in the adults, the most common causes include viral and ascaris infections, drugs, traumas, and structural abnormalities. The objective of this study was to report a case of a severe non-alcoholic and non-biliary acute pancreatitis in a 15-year-old patient, whose propedeutic imaging showed a loop communicating with the ventral and dorsal pancreatic ducts, consistent with ansa pancreatica.

A rare case of recurrent acute pancreatitis after EUS-FNA in a patient with pancreatic intraepithelial neoplasia type 2 / Un raro caso de pancreatitis aguda recurrente después de EUS-FNA en un paciente con neoplasia intraepitelial tipo 2

Pancreatic intraepithelial neoplasia (PanIN) is considered a pre-malignant lesion difficult to identify by imaging methods. EUS- FNA is an effective technique to obtain material for histopathological study of pancreatic cystic tumors, but it is not free of adverse events. We report a case of a 56 years old patient, with chronic abdominal pain (early 1994). MRI showed pancreatic cystic images. The etiologic diagnosis was doubtful and EUS-FNA was performed. Immediately after a FNA, patient had an episode of acute pancreatitis, requiring hospitalization. During one year after FNA he had five episodes of AP. A new EUS suspected of PanIN, which was confirmed by surgery. After surgery the patient is well and has no more episodes of AP. Although the risk of AP, EUS-FNA should be performed to determine the best treatment for these patients with chronic abdominal pain who have cystic changes of pancreatic gland.

La neoplasia intraepithelial pancreática (PanIN) es considerada una lesión premaligna con dificultad diagnostica mediante métodos imagenlógicos. La EUS-FNA es una técnica efectiva para obtener material para el estudio histopatológico de tumores quísticos pancreáticos, pero no está libre de efectos adversos. Nosotros reportamos un caso de un paciente de 56 años de edad, con dolor abdominal cronico (desde 1994). En la resonancia abdominal se observó un quiste pancreático. El diagnostico etiológico fue dudoso y EUS-FNA fue realizada, después de la cual el paciente presento un cuadro de pancreatitis, requiriendo hospitalización. Durante el periodo de un año posterior a la FNA, éste presento cinco episodios de pancreatitis aguda. Un nuevo estudio ecoendoscopico dio la sospecha de PanIN, la cual se confirmó con la realización de la cirugía. Después de la cirugía quedo asintomático y sin presentar nuevos episodios de pancreatitis aguda hasta el momento. Aunque exista riego de pancreatitis aguda, la EUS-FNA debe realizarse para determinar el mejor tratamiento para pacientes con dolor abdominal crónico que tienen cambios quísticos de la glándula pancreática.

Management Algorithm of Pancreatic Calculi / 대한췌담도학회지

Pancreatic calculi associated with chronic pancreatitis lead to severe abdominal pain, which significantly reduces the quality of life of patients. Pancreatic calculi, especially those that obstruct the main pancreatic duct and cause abdominal pain, are considered to be treated. First, if pancreatic calculi are located in the head or body and the size is less than 5 mm, endoscopic removal can be attempted. If the size is greater than 5 mm, extracorporeal shockwave lithotripsy may be performed first, and subsequent endoscopic removal may be considered depending on the results. If such treatment fails, pancreatoscopic lithotripsy or surgery should be considered. Pancreatic duct stenting may be used as a bridge therapy during this process.

Diagnostic value of endoscopic ultrasonography in patients with biliary-pancreatic duct dilatation / 中华肝胆外科杂志

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD).Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional uhrasonography (US) were re-examined by EUS,CT and MRI.The diagnostic rates of EUS and the other imaging technologies were compared.Results All the 45 patients underwent successful EUS examination.Among them,there were 18 patients with periampullary tumor,10 patients with lower common bile duct stones,1 patient with pancreatic duct stones,3 patients with chronic pancreatitis,1 patient with an intrapancreatic choledochal cyst,4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis.However,1 patient with a lower common bile duct tumor,1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed.The diagnostic rates of obstructive lesions by US,EUS,CT and MRI were 7.1％,92.9％,33.3％,31.0％,respectively.The diagnostic rates of tumor were 10.0％,90.0％,35.0％,25.0％,respectively.As compared with the other examination methods,EUS was best in detecting small carcinoma.Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation.

Management of Benign and Malignant Pancreatic Duct Strictures

The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology

BACKGROUND/AIMS: Groove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published. METHODS: Seven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed. RESULTS: There were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2–24 vs 2, respectively) for GP and other complications associated with CP. CONCLUSIONS: Disconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.

A Case of an AUPBD Treated by Drainage of Major Papilla / 대한췌담도학회지

Anomalous union of the pancreaticobiliary duct (AUPBD) is a rare congenital anomaly, defined as the pancreaticobiliary ductal union located outside of the duodenal wall, usually forming a markedly long common channel. This anomaly is associated with congenital choledochal cyst, carcinoma of the biliary tract and pancreatitis, and is more commonly seen in Asian than in Western countries. AUPBD is frequently accompanied by biliary dilatation, but some patients with AUPBD have no biliary dilatation. The causal relationship between AUPBD and biliary dilatation associated with this anomaly has not been fully established. Here, we report a case of type IIIc2 AUPBD without biliary duct dilatation that was treated by drainage of major papilla.

Occurrence factors analysis of duodenobiliary reflux after endoscopic duodenal sphincterotomy / 重庆医学

Objective To investigate the occurrence factors of duodenobiliary reflux (DBR) after endoscopic sphincterotomy (EST ) .Methods A total of 198 patients with choledocholithiasis hospitalized in the digestive department of the hospital from Sep-tember 2012 to February 2016 were selected and given duodenal papilla EST .The DBR occurrence was judged and the occurrence factors were investigated ,meanwhile the Oddi sphincter function was measured and long term complications were followed up .Re-sults All patients successfully completed EST ,the average common bile duct diameter in 198 cases was (2 .24 ± 0 .24)cm ,the aver-age common bile duct stones number was 3 .63 ± 1 .12 ;the maximum diameter of common bile duct stones was (1 .02 ± 0 .19)cm . There were 12 cases of DBR after EST ,the occurrence rate was 6 .1% ,the average radioactivity was (3 .39 ± 0 .89)MBq .The post-operative Oddi sphincter systolic peak and contraction frequency were (31 .49 ± 4 .22)mm Hg and (3 .78 ± 0 .53) times /min ,which were significantly lower than those before operation (P<0 .05);and the postoperative Oddi sphincter basic pressure and common bile duct pressure were (8 .23 ± 1 .03)mm Hg and (3 .32 ± 0 .45)mm Hg respectively ,which had no statistical difference compared with preoperation (P>0 .05) .The Logistic regression analysis showed that complicating gallbladder stone ,diameter of common bile duct ,frequency difference of Oddi sphincter contraction before and after operation ,number of stones and maximum diameter of stone were the main risk factors for postoperative DBR occurrence (P<0 .05) .All cases were followed up for 6 months ,18 cases developed long term complications ,the incidence rate was 9 .1% ,including 4 cases of reflux cholangitis ,6 cases of bile duct stric-ture ,4 cases of papillary stenosis and 4 cases of recurrence .Conclusion DBR after duodenal papilla EST is common ,which can re-sult in the Oddi sphincter function decrease and increase of long-term complications ,and needs to actively strengthen prevention and management .

Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions

Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD.

Pancreatic duct stenting for prevention of post-ERCP pancreatitis: A meta-analysis / 解放军医学杂志

Objective To evaluate the role of pancreatic duct stenting in the prevention of post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP).Methods The literature and corresponding references of randomized controlled trials (RCT) on pancreatic duct stenting for the prevention of PEP were searched from Cochrane Library (1970 to Aug. 2015), PubMed (1966 to Aug. 2015), EMBASE (1966 to Aug. 2015) and China Biology Medicine disc (1978 to Aug. 2015). Literature screening, data extraction, and methodological quality assessment were individually performed by two researchers.The software RevMan 5.3 of Cochrane Collaboration was used for statistical analysis. Results A total of 23 articles with 2556 patients were included in the present study. The result of Meta analysis showed that: compared with the control, pancreatic duct stenting could effectively prevent PEP (RR=0.34, 95%CI: 0.27-0.43, P<0.00001) from occurrence and alleviate the severity of PEP (RR=0.18, 95%CI: 0.08-0.42, P<0.0001). Conclusion Pancreatic duct stenting may effectively prevent the occurrence and alleviate the severity of PEP.

Relationship between Anomalous Pancreaticobiliary Ductal Union and Pathologic Inflammation of Bile Duct in Choledochal Cyst / 대한소아소화기영양학회지

PURPOSE: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with choledochal cyst in a single institute for 25 years. METHODS: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children's Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of choledochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani's classification, and relationship between APBDU and surgical pathology. RESULTS: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another. CONCLUSION: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.

A Case of Squamoid Cyst of Pancreatic Ducts Shown Malignant Behavior / 대한췌담도학회지

Detection of cystic lesions in the pancreas has increased because of the widespread use of high-resolution diagnostic imaging techniques. Therefore, cystic lesions of the pancreas constitute an increasingly important category with a challenging differential diagnosis. Squamoid cyst of pancreatic ducts is a recently recognized type of cystic lesion in the pancreas in which cystically dilated ducts are lined by non-keratinized squamous epithelium. Although it is clinically known as benign cystic lesion, we experienced its malignant behavior and report here with review of the international literatures.

Safety and Effectiveness of Successive Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis under Intravenous Bolus Pethidine Administration Alone / 대한소화기학회지

BACKGROUND/AIMS: A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone. METHODS: Ninety patients with calcified pancreatic stones (> or =5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy. RESULTS: A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5+/-20.7 mg per session. As ESWL-related complications, four (4.3%) patients developed mild acute pancreatitis. CONCLUSIONS: In case of endoscopically difficult-to-treat pancreatic duct stones, combined therapy with ESWL is an effective method, and treatment with multiple sessions of ESWL on successive days under intravenous bolus of pethidine alone is safe and well tolerated.

Analysing Factors Causing Pancreatic Fistula post Pancreaticoduodenectomy with External Drainage of Pancreatic Duct / 天津医药

Objective To analyze relevant factors causing pancreatic fistula post pancreaticoduodenectomy with ex-ternal drainage of pancreatic duct. Methods Altogether 133 patients who underwent pancreaticoduodenectomy with exter-nal drainage of pancreatic duct in our hospital from 1999 to 2011 were retrospectively analyzed. Logistic regression analysis was used to analyze the relevance of pancreatic fistula with age, gender, combined diseases, pancreatic duct diameter, patho-logical types, preoperative total bilirubin (TBIL), albumin (ALB) levels, drainage of the bile duct before operation, obstruc-tion of the pancreatic duct drainage and postoperative application of growth somatostatin. Then we also analyzed the relation-ship between those risk factors and the severity of pancreatic fistula. Results Postoperative pancreatic fistula occurred in 24 cases (3 cases were of grade A,13 cases were of grade B and 8 cases were of grade C) among the 133 patients. Logistic re-gression analysis showed that obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula in these patients(OR=4.529,P=0.005). The patients whose pancreatic duct drainage was obstructed had a significantly higher pan-creatic fistula rate than the patients whose drainage was not obstructed (30.8%vs 12.8%, P＜0.05). The occurrence of pan-creatic fistula has no significant correlation with age, gender, combined diseases, pancreatic duct diameter, pathological types, preoperative TBIL, ALB level, preoperative bile duct drainage and postoperative application of somatostatin. What’s more, in those pancreatic fistula patients, the pancreatic fistulas were more severe in the obstructed ones than those in the un-obstructed ones. Conclusion The obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula post pancreaticoduodenectomy with external drainage of pancreatic duct. If adequate preventive measures were employed during operation , the incidence of pancreatic fistula and pancreatic fistula severity will be significantly reduced.