RESUMO
INTRODUCTION: In median arcuate ligament syndrome (MALS), the celiac artery is compressed, causing an arcade to develop in the pancreatic head, leading to ischemic symptoms and aneurysms. PATIENT CONCERNS: The patient was diagnosed with borderline resectable pancreatic cancer (PC) and MALS. Endoscopic biliary drainage with a covered metal stent (CMS) was performed for the obstructive jaundice. After the jaundice improved, a modified FOLFIRINOX regimen was initiated. Several days later, cardiopulmonary arrest occurred after hematemesis occurred. Cardiopulmonary resuscitation was performed, his blood pressure stabilized, and emergent upper endoscopy was performed. The CMS was dislodged and active bleeding was observed in the papillae. The CMS was replaced, and temporary hemostasis was achieved. Contrast-enhanced computed tomography revealed a diagnosis of extravasation from the posterior superior pancreaticoduodenal artery (PSPDA) into the biliary tract. Transcatheter arterial embolization was performed. However, the patient was subsequently diagnosed with hypoxic encephalopathy and died on day 14 of hospitalization. DIAGNOSIS: Biliary hemorrhage due to invasion of pancreatic cancer from the PSPDA associated with MALS. INTERVENTION: None. OUTCOMES: Biliary hemorrhage from the PSPDA was fatal in the patient with invasive PC with MALS. LESSONS: Since MALS associated with PC is not a rare disease, the purpose of this study was to keep in mind the possibility of fatal biliary hemorrhage.
Assuntos
Hemobilia , Síndrome do Ligamento Arqueado Mediano , Neoplasias Pancreáticas , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica , Hemobilia/etiologia , Hemorragia/complicações , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias PancreáticasRESUMO
Yamamoto et al. report two cases of endoscopic closure using an over-the-scope clip for scope-induced perforation encountered during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, respectively. In a supporting video, they explain how to prepare the over-the-scope clip and clearly show how the actual procedures were performed.
Assuntos
Úlcera Duodenal , Humanos , Endoscopia Gastrointestinal/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endossonografia , Instrumentos Cirúrgicos/efeitos adversosRESUMO
EUS-guided drainage using a lumen-apposing metal stent (LAMS) has demonstrated promising clinical efficacy for peripancreatic fluid collection. However, intracavitary bleeding has been reported after LAMS placement. Yamamoto et al. reported endoscopic hemostasis using hemostatic gel for intracavitary bleeding.
Assuntos
Endossonografia , Hemostáticos , Humanos , Stents , Hemorragia , Drenagem , Hemostáticos/uso terapêuticoRESUMO
A novel biliary drainage system consisting of an integrated biliary stent and nasobiliary drainage catheter system is expected to be clinically useful. However, Yamamoto and colleagues report two cases of acute cholecystitis after use of the system, suggesting that there are risks of adverse events associated with its unique design.
Assuntos
Sistema Biliar , Colecistite Aguda , Humanos , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/etiologia , Colecistite Aguda/cirurgia , Catéteres/efeitos adversos , Stents/efeitos adversosRESUMO
BACKGROUND/PURPOSE: Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. METHODS: We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed. RESULTS: SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P = 0.001, ECP vs CP; P = 0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P = 0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P = 0.0006, ECP vs CP; P = 0.0027). CONCLUSION: Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP.
Assuntos
Técnicas de Imagem por Elasticidade , Pancreatite Crônica , Humanos , Técnicas de Imagem por Elasticidade/métodos , Pancreatite Crônica/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Ultrassonografia , FígadoRESUMO
PuraStat is a novel self-assembling peptide hydrogel developed as a hemostatic agent for endoscopic and surgical procedures which can be applied to bleeding from various lesions of the gastrointestinal tract. Yamamoto and colleagues present a video showing the actual endoscopic hemostasis using PuraStat for endoscopic sphincterotomy-related bleeding.
Assuntos
Hemostáticos , Esfinterotomia Endoscópica , Colangiopancreatografia Retrógrada Endoscópica/métodos , Hemostáticos/uso terapêutico , Humanos , Hidrogéis , Peptídeos , Estudos Retrospectivos , Esfinterotomia Endoscópica/métodos , Resultado do TratamentoRESUMO
Management of papillary stenosis after endoscopic papillectomy is technically challenging. Yamamoto et al. report a case of successful biliary cannulation for bile duct stenosis after endoscopic papillectomy using the "guidewire placed in the scope" technique, which is a hybrid procedure that combines the advantages of conventional endoscopic ultrasound-guided rendezvous techniques.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Constrição Patológica , Cateterismo/métodos , Ductos Biliares , Ultrassonografia de IntervençãoRESUMO
Highlight In this report of a rare case of obstructive jaundice caused by dilatation of cancerous gland ducts associated with advanced pancreatic cancer, Ryozawa and colleagues describe their method of endoscopic ultrasound-guided transmural drainage with a lumen-apposing metal stent as a novel treatment option for malignant biliary obstruction.
Assuntos
Colestase , Cistos , Neoplasias Pancreáticas , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/cirurgia , Cistos/complicações , Drenagem/métodos , Endossonografia/métodos , Humanos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Stents/efeitos adversos , Ultrassonografia de Intervenção , Neoplasias PancreáticasRESUMO
Afferent loop syndrome is a late adverse event after gastrojejunostomy which involves increased intraluminal pressure, progresses rapidly, and requires appropriate decompression treatment. Patients in poor condition require less invasive treatments. Yamamoto and colleagues report a case of successful treatment of malignant afferent loop syndrome with hemorrhage by endoscopic ultrasound-guided gastrojejunostomy.
Assuntos
Síndrome da Alça Aferente , Derivação Gástrica , Síndrome da Alça Aferente/diagnóstico por imagem , Síndrome da Alça Aferente/etiologia , Síndrome da Alça Aferente/cirurgia , Endossonografia , Derivação Gástrica/efeitos adversos , Hemorragia , Humanos , Ultrassonografia de IntervençãoRESUMO
We herein report two cases of hemorrhagic ampullary lesions in which endoscopic papillotomy was performed to control bleeding and resulted in successful treatment. Both patients were pathologically diagnosed with an underlying pathology characterized by inflammatory cell infiltration and capillary proliferation. They also had disposing factors for bleeding, such as antithrombotic therapy and idiopathic thrombocytopenic purpura. Endoscopic treatment was selected because the risk of surgical resection was high due to the patients' hemorrhagic condition. Both patients were successfully treated without any serious adverse events and had an uneventful postoperative course with no relapse of bleeding.
Assuntos
Ampola Hepatopancreática , Hemorragia , Ampola Hepatopancreática/cirurgia , Hemorragia/terapia , Humanos , Esfinterotomia Endoscópica , Resultado do TratamentoRESUMO
High-intensity focused ultrasound (HIFU) is a novel advanced therapy for unresectable pancreatic cancer (PC). HIFU therapy with chemotherapy is being promoted as a novel method to control local advancement by tumor ablation. We evaluated the therapeutic effects of HIFU therapy in locally advanced and metastatic PC. PC patients were treated with HIFU as an optional local therapy and systemic chemotherapy. The FEP-BY02 (Yuande Bio-Medical Engineering) HIFU device was used under ultrasound guidance. Of 176 PC patients, 89 cases were Stage III and 87 were Stage IV. The rate of complete tumor ablation was 90.3%, while that of symptom relief was 66.7%. The effectiveness on the primary lesions were as follows: complete response (CR): n = 0, partial response (PR): n = 21, stable disease (SD): n = 106, and progressive disease (PD): n = 49; the primary disease control rate was 72.2%. Eight patients underwent surgery. The median survival time (MST) after diagnosis for HIFU with chemotherapy compared to chemotherapy alone (100 patients in our hospital) was 648 vs. 288 days (p < 0.001). Compared with chemotherapy alone, the combination of HIFU therapy and chemotherapy demonstrated significant prolongation of prognosis. This study suggests that HIFU therapy has the potential to be a novel combination therapy for unresectable PC.