ABSTRACT
The easiest way to drain the bile duct or the main pancreatic duct by means of ERCP is the insertion of a plastic stent. Once cannulation has been achieved, which is generally the most complex and limiting step in ERCP, stent insertion is straightforward and rewarding. The main problem in benign pancreato-biliary conditions comes in the follow-up. Indications for biliary stent insertion in non-neoplastic diseases are common bile duct (CBD) stones that could not be completely extracted, benign strictures and leaks. In the pancreas stents are frequently inserted to prevent post-ERCP pancreatitis and for benign strictures and other less frequent conditions such as main pancreatic duct disruption. Currently in all centers more and more ERCPs are performed in patients without naive Papilla of Vater, generally for stent extraction or exchange. For example, in the recent study by Barakat and Banerjee, carried out in a tertiary care academic medical center, only 25% were index or initial ERCP, without previous sphincterotomy or stent, and subsequent procedures comprised the remaining 75 %. (AU)
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Constriction, Pathologic , Gallstones , Sphincterotomy, Endoscopic/methods , Retrospective Studies , StentsABSTRACT
The easiest way to drain the bile duct or the main pancreatic duct by means of ERCP is the insertion of a plastic stent. Once cannulation has been achieved, which is generally the most complex and limiting step in ERCP, stent insertion is straightforward and rewarding. The main problem in benign pancreato-biliary conditions comes in the follow-up. Indications for biliary stent insertion in non-neoplastic diseases are common bile duct (CBD) stones that could not be completely extracted, benign strictures and leaks. In the pancreas stents are frequently inserted to prevent post-ERCP pancreatitis and for benign strictures and other less frequent conditions such as main pancreatic duct disruption. Currently in all centers more and more ERCPs are performed in patients without naive Papilla of Vater, generally for stent extraction or exchange. For example, in the recent study by Barakat and Banerjee, carried out in a tertiary care academic medical center, only 25% were index or initial ERCP, without previous sphincterotomy or stent, and subsequent procedures comprised the remaining 75 %.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Gallstones , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Constriction, Pathologic , Humans , Retrospective Studies , Sphincterotomy, Endoscopic/methods , StentsABSTRACT
No disponible
Subject(s)
Humans , Urinary Bladder Calculi/surgery , Choledocholithiasis/surgery , Cholelithiasis/surgery , Cholecystectomy, Laparoscopic/methods , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholecystectomy/methods , Postcholecystectomy Syndrome/diagnostic imagingABSTRACT
The authors analyze what should be the best approach to treat patients who had concomitant gallstones and common bile duct stones (CBDS). Laparoscopic common bile duct exploration (LCBDE) appears to be an atractive way to cure all kind of biliary stones in a single procedure. However, when scientific literature is reviewed most patients continue to need from ERCP for CBDS removal. ERCP can be performed before, after or during the same LC procedure. Patients with LCBDE had less pancreatitis rate because the Papilla of Vater is not manipulated but more bile leaks. Large CBDS continue to need, in general, from ERCP techniques.
Subject(s)
Cholecystectomy, Laparoscopic , Choledocholithiasis , Gallstones/surgery , Laparoscopy , Aged , Cholangiopancreatography, Endoscopic Retrograde , Cohort Studies , Common Bile Duct , Humans , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde/trends , Common Bile Duct Diseases/surgery , Patient Safety , Sphincterotomy, Transduodenal/trendsABSTRACT
The term "ERCP cannulation" returns 1,563 items in Pubmed. In 1980 there were 7 papers, and 92 were included in 2015. Any gastroenterologist knows ERCP is often a complex procedure, at times with uncertain results, that unfortunately leads every so often to lawsuits. Most issues derive from attempts at biliary cannulation, despite the improved instruments available since the days of the first sphincterotomy back in 1974. The initial priority goal of ERCP learning is a satisfactory rate of choledochal cannulation. Such rate has been somewhat arbitrarily set as at least 80% of successful biliary access.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Sphincterotomy, Endoscopic , Catheterization , Common Bile Duct , Humans , PancreatitisABSTRACT
Pancreatic metastases represent 2% of pancreatic tumors. The neoplasms most frequently metastasizing to the pancreas are breast, lung, melanoma and kidney tumors. We present the cases of two patients with pancreatic metastases from renal carcinoma diagnosed 4 and 8 years after the diagnosis and surgical treatment of the primary renal tumor. In both patients, endoscopic ultrasound was useful in the detection and characterization of these pancreatic lesions and allowed fine-needle aspiration for cytological study to be performed.
Subject(s)
Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/secondary , Endosonography , Kidney Neoplasms , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/secondary , Biopsy, Needle , Carcinoma, Renal Cell/pathology , Female , Humans , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Middle Aged , Nephrectomy , Pancreas/pathology , Pancreatectomy , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Radiography, Abdominal , Radiography, Thoracic , Time Factors , Tomography, X-Ray ComputedABSTRACT
Las metástasis pancreáticas representan el 2% de los tumores pancreáticos. Las neoplasias que con más frecuencia metastatizan en el páncreas son: mama, pulmón, melanoma y riñón. Presentamos los casos clínicos de 2 pacientes con metástasis pancreáticas de carcinoma renal detectadas a los 4 y 8 años del diagnóstico e intervención quirúrgica del tumor primario renal. En ambos casos la ecoendoscopia resultó ser una técnica útil en la detección y la caracterización de estas lesiones pancreáticas, y permitió la realización de una punción para el estudio citológico
Pancreatic metastases represent 2% of pancreatic tumors. The neoplasms most frequently metastasizing to the pancreas are breast, lung, melanoma and kidney tumors. We present the cases of two patients with pancreatic metastases from renal carcinoma diagnosed 4 and 8 years after the diagnosis and surgical treatment of the primary renal tumor. In both patients, endoscopic ultrasound was useful in the detection and characterization of these pancreatic lesions and allowed fine-needle aspiration for cytological study to be performed