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Ponz de Leon Pisani R, Altieri G, Stasio RC, Lazzano P, Reni M, Falconi M, Vanella G, Arcidiacono PG, Capurso G. Gastrointestinal symptoms in the journey of pancreatic cancer patients. Expert Rev Anticancer Ther 2025. [PMID: 40489240 DOI: 10.1080/14737140.2025.2517888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 06/04/2025] [Accepted: 06/05/2025] [Indexed: 06/11/2025]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy frequently arising with nonspecific and overlooked gastrointestinal symptoms. Gastroenterologists are typically the first specialists to encounter these patients, positioning them to play a pivotal role not only in early diagnosis, but also in the ongoing management of the disease's complex symptom burden. AREAS COVERED This review explored gastrointestinal symptoms in patients with PDAC (ranging from pain and diarrhea to anorexia, jaundice, and nausea) and outlined both tumor- and treatment-related causes. A literature review based on non-systematic PubMed search updated to April 2025 was conducted to summarize current diagnostic strategies, medical, endoscopic therapies, and multidisciplinary management approaches. In addition, we present original data from a single-center cohort, suggesting that the involvement of gastroenterologists leads to more comprehensive management of gastrointestinal symptom control and supportive care. EXPERT OPINION Collaboration among specialists is essential for optimizing patient outcomes in the multidisciplinary management of PDAC. Gastroenterologists' 'stewardship' significantly contributes to prompt diagnosis, symptom control, quality of life preservation, and prognosis. Future priorities should focus on strengthening integration within care pathways, fostering interdisciplinary coordination, and implementing shared clinical tools to enhance comprehensive patient care. A well-structured team-based approach is key to advancing holistic PDAC management.
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Affiliation(s)
- Ruggero Ponz de Leon Pisani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Altieri
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosa Claudia Stasio
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pilar Lazzano
- Gastroenterology and Hepatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Reni
- Oncology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
| | - Massimo Falconi
- "Vita-Salute" San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
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Lu WH, Chao YJ, Liao TK, Su PJ, Wang CJ, Shan YS. Effect of internal pancreatic duct stent on reducing long-term pancreaticojejunostomy stenosis following pancreaticoduodenectomy. Langenbecks Arch Surg 2025; 410:51. [PMID: 39869223 PMCID: PMC11772507 DOI: 10.1007/s00423-025-03622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 01/17/2025] [Indexed: 01/28/2025]
Abstract
BACKGROUND As survival following PD improved, long-term complications have emerged as an issue in current era. Pancreaticojejunostomy stenosis is the common long-term sequel after PD but rarely addressed. This study aimed to investigate the benefit of pancreatic duct stent in reducing PJ stenosis after PD. METHODS Between July 2006 and July 2019, patients undergoing PD with follow-up more than 1 year were recruited. Patients were divided into internal stent, external stent, and no stent groups. We reviewed the Computed tomography (CT) to measure the diameter of pancreatic duct and stent migration at 3 months and 1 year after PD. PJ stenosis was defined as pancreatic duct diameter > 3 mm. Perioperative variables were collected for analysis. RESULTS Totally, 506 patients were included 349 patients in internal stent group, 84 patients in the external stent, and 73 patients in no stent group. There was no difference in preoperative P-duct size between the IS and ES group (3.39 ± 1.78 mm vs 3.26 ± 1.89 mm, p = 0.481), while the P-duct size was larger in ES group compared to the IS group (3.22 ± 2.44 mm vs. 1.94 ± 2.08 mm, p < 0.001) one year after PD. In the internal stent group, the rate of stent migration was 22.1% at 3 months and 67.9% at 1 year post-operatively. CR-POPF (OR 2.24, p = 0.015) and P-duct stent retention at PJ > 3 months (OR 0.45, p < 0.001) were the independent factors for 1-year PJ stenosis in multivariate analysis. CONCLUSION Retention of internal pancreatic duct stents at the anastomosis for more than 3 months can reduce post-PD PJ stenosis. Extended retention of internal pancreatic duct stents reduces PJ stenosis, highlighting its critical role in preventing long-term complications.
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Affiliation(s)
- Wei-Hsun Lu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ying-Jui Chao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ting-Kai Liao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Chih-Jung Wang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan.
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan.
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Li Y, Yu T, Zhang L, Hou Y, Tian J, Hou S. Endoscopic ultrasound combined with enteroscopy for bilioenterostomy stenosis after pancreatoduodenectomy. The first attempt of a two-person operation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:712-713. [PMID: 38031918 DOI: 10.17235/reed.2023.10072/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Bilioenterostomy stenosis is very challenging, and effective endoscopic treatment can prevent patients from undergoing surgery. We present a case of a patient with extremely narrow bilioenterostomy treated with simultaneous endoscopic ultrasonography and enteroscopy. It provides a new and feasible idea of endoscopic therapy for the treatment of such patients.
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Affiliation(s)
- Yaoting Li
- Biliopancreatic Endoscopic Surgery , The Second Hospital of Hebei Medical University, China
| | - Tingting Yu
- Biliopancreatic Endoscopic Surgery , The Second Hospital of Hebei Medical University, China
| | - Lichao Zhang
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, china
| | - Yankun Hou
- Biliopancreatic Endoscopic Surgery , The Second Hospital of Hebei Medical University, China
| | - Jiao Tian
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, China
| | - Senlin Hou
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, China
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Capasso M, Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Bravo M, Palermo A, Fimiano F, Mutignani M. Endoscopic approach for biliopancreatic disease after pancreaticoduodenectomy: a 10-year single-center experience. Surg Endosc 2024; 38:5187-5198. [PMID: 39043884 DOI: 10.1007/s00464-024-11095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/14/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND AIM In surgically altered anatomy (SAA), endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, and it remains debatable the choice of the optimal endoscopic approach within this context. We aim to show our experience and evaluate the technical and clinical success of endoscopic treatment performed in the setting of adverse events (AE) after pancreaticoduodenectomy (PD). METHODS This study was conducted on a retrospective cohort of patients presenting biliopancreatic complications after PD from 01/01/2012 to 31/12/2022. All patients underwent ERCP at our Endoscopy Unit. Clinical, instrumental data, and characteristics of endoscopic treatments were collected. RESULTS 133 patients were included (80 M, mean age = 65 y.o.) with a total of 296 endoscopic procedures (median = 2 procedures/treatment). The indications for ERCP were mainly biliary AE (76 cases, 57.1%). Technical success was obtained in 121 patients of 133 (90.9%). 112 out of 133 (84.2%) obtained clinical success. Nine patients out of 112 (8%) experienced AEs. Clinical success rates were statistically different between patients with biliary or pancreatic disease (93.4% vs 73.6%, p < 0.0001). Septic patients were 38 (28.6%) and showed a worse prognosis than non-septic ones (clinical success: 65.7% vs 91.5%, p = 0.0001). During follow-up, 9 patients (8%), experienced recurrence of the index biliopancreatic disease with a median onset at 20 months (IQR 6-40.1). CONCLUSION Our case series demonstrated that the use of a pediatric colonoscope in ERCP procedures for patients with AEs after PD is both safe and effective in treating the condition, even in a long-term follow-up.
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Affiliation(s)
- Mario Capasso
- Gastroenterology and Endoscopy Department, ASST Maggiore Hospital, Largo Ugo Dossena 2, 26013, Crema (CR), Italy
- Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy.
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Marianna Bravo
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Andrea Palermo
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Federica Fimiano
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza Dell'Ospedale Maggiore 3, 20161, Milan, Italy
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Wang RY, Fan Z. Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:490-500. [DOI: 10.11569/wcjd.v32.i7.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2024]
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Narvaez Salas D, Roldan-Vasquez E, Negrete Ocampo R, Ballagan Escobar R, Roldan Crespo J. Surgical treatment of pancreaticojejunal stenosis after pancreaticoduodenectomy: case report. J Surg Case Rep 2024; 2024:rjae239. [PMID: 38863956 PMCID: PMC11165309 DOI: 10.1093/jscr/rjae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 06/13/2024] Open
Abstract
Pancreaticoduodenectomy is established as the procedure of choice for malignant tumor pathologies of the head of the pancreas or ampulla, where the patient's life prognosis is low. Complications after pancreaticoduodenectomy (e.g. pancreatic fistulas, hemorrhages, or intra-abdominal collection) are well described in the literature and are generally acute. However, there is still a small risk for late complications (e.g. pancreatitis, pancreatic insufficiency), and due to its low incidence, there has not been a consensus on the treatment. We present the case of an 18-year-old female with recurrent bouts of acute pancreatitis as a late complication of a pancreaticoduodenectomy plus pancreatojejunal anastomosis due to a pseudopapillary tumor of the pancreas. The complication was managed though surgical revision consisting of dilation and stent placement in the stenosis. The patient had an adequate postoperative evolution without further complications. Despite the advances in the surgical field, pancreaticoduodenectomy represents a highly complex surgery with high morbidity and mortality rates. The late complications of this surgery are under continuous study due to its low incidence associated with low patient survival.
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Affiliation(s)
- David Narvaez Salas
- Departamento de Cirugía General, Hospital Vozandes Quito, Quito 170521, Ecuador
| | | | - Ricardo Negrete Ocampo
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Romina Ballagan Escobar
- School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador
| | - Juan Roldan Crespo
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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Park J, Han K, Kwon JH, Kim MD, Won JY, Moon S, Kim GM. Feasibility of Percutaneous Pancreatic Stent Placement in Postoperative Pancreaticojejunostomy Stenosis. Korean J Radiol 2023; 24:1241-1248. [PMID: 38016683 PMCID: PMC10700988 DOI: 10.3348/kjr.2023.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To evaluate the role of percutaneous pancreatic stent placement in postoperative pancreaticojejunostomy stenosis (PJS). MATERIALS AND METHODS This retrospective single-center study included seven procedures in five patients (four males and one female; median age, 63 years) who underwent percutaneous pancreatic stent placement for postoperative PJS between January 2005 and December 2021. The patients were referred to interventional radiology because of unfavorable anatomy or bowel abnormalities. The pancreatic duct was accessed under ultrasound and/or computed tomography guidance. A stent was placed after balloon dilatation of the PJS. Moreover, plastic stents were placed for the first two procedures, whereas bare-metal stents were used for the remaining five procedures. Technical success was defined as the successful placement of stents for the PJS, meanwhile, clinical success was defined as the normalization of pancreatic enzymes without recurrence of pancreatitis. RESULTS Pancreatic duct access and stent placement were successfully performed in all patients (technical success rate: 100%). All the procedures initially yielded clinical success. However, recurrence of pancreatitis was observed after two procedures that used plastic stents because of stent migration at 0.3 and 3 months after the procedure. In contrast, no instances of recurrent pancreatitis were noted after metal stent placement for a follow-up duration of 1-36 months. No serious procedure-related adverse events were observed. CONCLUSION Percutaneous pancreatic stent placement may be a viable option for patients with postoperative PJS in whom an endoscopic approach is not feasible. Metal stents may be considered over plastic stents for the management of PJS, considering the possible lower stent migration and infeasibility of frequent endoscopic stent exchange due to the altered anatomy.
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Affiliation(s)
- Juil Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kichang Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungmo Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyoung Min Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Guo F, Huang S, Wolde TG, Lu Z, Chen J, Wu J, Gao W, Jiang K, Miao Y, Wei J. Surgical revision for pancreatojejunostomy stricture: a case series of 14 patients. BMC Surg 2022; 22:318. [PMID: 35982438 PMCID: PMC9389657 DOI: 10.1186/s12893-022-01767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pancreatojejunostomy stricture (PJS) is a rare long-term complication of pancreaticojejunal anastomosis. This study aimed to investigate the role of surgery in the management of pancreatojejunostomy strictures. Methods The database of the Pancreas Center of Nanjing Medical University was retrospectively screened for patients who underwent a surgical revision for PJS between June 2012 and August 2019, and their clinical characteristics and management modalities were reviewed. Results Fourteen consecutive cases were retrieved, the median age at index operation was 41.1 years (19–71). The average time between the two operations was 70.6 months (8–270 months). Index procedures included pancreaticoduodenectomy (PD) (7/14, 50%), pylorus-preserving PD (4/14, 28.6%), Berger procedure (2/14, 14.3%), and middle pancreatectomy (1/14, 7.1%). The diameter of the main pancreatic duct was < 4 mm in all 14 cases, and nine underwent pancreaticojejunostomy (PJ) stenting during the index operation. The most frequent complaints were abdominal pain (6/14, 42.9%), recurrent acute pancreatitis (6/14, 42.9%), pancreatic fistula (1/14, 7.1%), and abdominal distention (1/14, 7.1%). The diagnosis of PJ stricture was confirmed by computed tomography or magnetic resonance imaging in all cases. All patients had a main duct diameter > 5 mm before surgical revision. All patients underwent wedge excision with interrupted one-layer suturing with absorbable sutures and without stent placement. In this series, only one patient required reoperation. Upon follow-up, 11 of 12 patients had complete resolution of the PJ stricture. Conclusion PJS is a long-term complication of pancreatojejunostomy. Surgical revision of the anastomosis is a safe and effective treatment modality.
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Affiliation(s)
- Feng Guo
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shimeng Huang
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tewodross Getu Wolde
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zipeng Lu
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianmin Chen
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junli Wu
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wentao Gao
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kuirong Jiang
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Miao
- BenQ Medical Center, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jishu Wei
- The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Yamamoto M, Zaima M, Yazawa T, Yamamoto H, Harada H, Yamada M, Tani M. Redo pancreaticojejunal anastomosis for late-onset complete pancreaticocutaneous fistula after pancreaticojejunostomy. World J Surg Oncol 2022; 20:223. [PMID: 35786384 PMCID: PMC9252026 DOI: 10.1186/s12957-022-02687-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pancreaticojejunal (PJ) anastomosis occasionally fails several months after pancreaticoduodenectomy (PD) with Child reconstruction and can ultimately result in a late-onset complete pancreaticocutaneous fistula (Lc-PF). Since the remnant pancreas is an isolated segment, surgical intervention is necessary to create internal drainage for the pancreatic juice; however, surgery at the previous PJ anastomosis site is technically challenging even for experienced surgeons. Here we describe a simple surgical procedure for Lc-PF, termed redo PJ anastomosis, which was developed at our facility. METHODS: Between January 2008 and December 2020, six consecutive patients with Lc-PF after PD underwent a redo PJ anastomosis, and the short- and long-term clinical outcomes have been evaluated. The abdominal cavity is carefully dissected through a 10-cm midline skin incision, and the PJ anastomosis site is identified using a percutaneous drain through the fistula tract as a guide, along with the main pancreatic duct (MPD) stump on the pancreatic stump. Next, the pancreatic stump is deliberately immobilized from the dorsal plane to prevent injury to the underlying major vessels. After fixing a stent tube to both the MPD and the Roux-limb using two-sided purse-string sutures, the redo PJ anastomosis is completed using single-layer interrupted sutures. Full-thickness pancreatic sutures are deliberately avoided by passing the needle through only two-thirds of the anterior side of the pancreatic stump. RESULTS The redo PJ anastomosis was performed without any intraoperative complications in all cases. The median intraoperative bleeding and operative time were 71 (range 10-137) mL and 123 (range 56-175) min, respectively. Even though a new mild pancreatic fistula developed postoperatively in all cases, it could be conservatively treated within 3 weeks, and no other postoperative complications were recorded. During the median follow-up period of 92 (range 12-112) months, no complications at the redo PJ anastomosis site were observed. CONCLUSIONS This research shows that the redo PJ anastomosis for Lc-PF we developed is a safe, feasible, and technically no demanding procedure with acceptable short- and long-term clinical outcomes. This procedure has the potential to become the preferred treatment strategy for Lc-PF after PD.
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Affiliation(s)
- Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan.
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
| | - Tekefumi Yazawa
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, 4-30 Moriyama 5-chomeShiga Prefecture, Moriyama City, 524-8524, Japan
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Gierek M, Merkel K, Ochała-Gierek G, Niemiec P, Szyluk K, Kuśnierz K. Which Suture to Choose in Hepato-Pancreatic-Biliary Surgery? Assessment of the Influence of Pancreatic Juice and Bile on the Resistance of Suturing Materials—In Vitro Research. Biomedicines 2022; 10:biomedicines10051053. [PMID: 35625790 PMCID: PMC9139064 DOI: 10.3390/biomedicines10051053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The choice of appropriate surgical suture during operation is of great significance. Currently, there are no objective studies regarding the resistance of commonly used sutures in biliary tract surgery. (2) Methods: This fact leads one to conduct research concerning the resistance of the sutures (Polydioxanone, Poliglecaprone, Poliglactin 910, and their analogues coated with antibacterial triclosan) in the environment of sterile and contaminated bile and pancreatic juice. Tensile strength was tested at days 0, 7, 14, 21, and 28 of research. The study was performed in in vitro conditions for 28 days. (3) Results: Pancreatic juice and bile has a significant influence on the tensile strength of each suture. (4) Conclusions: The study indicated that sutures made of polydioxanone had the best qualities during the entire experiment.
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Affiliation(s)
- Marcin Gierek
- Center for Burns Treatment im. Dr Sakiel, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
- Correspondence: (M.G.); (K.M.); Tel.: +48-6-6070-7704 (M.G.); +48-6-9834-2856 (K.M.)
| | - Katarzyna Merkel
- Institute of Materials Engineering, Faculty of Science and Technology, University of Silesia, ul. 75. Pułku Piechoty, 41-500 Chorzów, Poland
- Correspondence: (M.G.); (K.M.); Tel.: +48-6-6070-7704 (M.G.); +48-6-9834-2856 (K.M.)
| | - Gabriela Ochała-Gierek
- Dermatology Department, City Hospital in Sosnowiec, ul. Zegadłowicza 3, 41-200 Sosnowiec, Poland;
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia in Katowice, ul. Medyków 14, 40-752 Katowice, Poland;
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Rudler F, Caillol F, Ratone JP, Pesenti C, Valats JC, Soloveyv A, Giovannini M. EUS-guided drainage of the pancreatic duct for the treatment of postoperative stenosis of pancreatico-digestive anastomosis or pancreatic duct stenosis complicating chronic pancreatitis: Experience at a tertiary care center. Endosc Ultrasound 2022:336600. [PMID: 35083983 PMCID: PMC9526096 DOI: 10.4103/eus-d-21-00150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and Objectives For the treatment of pancreatic duct stenosis due to chronic pancreatitis (CP) or postoperative (PO) stenosis, endoscopic procedures are usually the first choice. In cases of failure of the recommended treatment by ERCP, anastomosis between the Wirsung duct and the stomach or duodenum can be performed under EUS guidance. The objective of this retrospective study was to compare the outcomes of pancreatico-gastric or pancreaticoduodenal anastomosis under EUS for PO stenosis versus CP stenosis. Subjects and Methods This was a retrospective, single-center, consecutive case study of patients who underwent EUS-guided Wirsungo-gastric/bulbar anastomosis. Results Forty-three patients were included. Twenty-one patients underwent treatment for PO stenosis, and 22 patients underwent treatment for CP stenosis. The technical success rate was 95.3% (41/43), with 100% in cases of PO stenosis and 90.9% in cases of CP stenosis. The clinical success rate was 72.5% (29/40): 75% (15/20) in cases of PO stenosis and 70% (14/20) in cases of CP stenosis. The overall morbidity rate was 34.9% (15/43). The main complication was postprocedural pain, occurring in 20.9% (9/443) of patients. The rate of stent migration or obstruction was 27.9% (12/43). There was no difference in patient outcomes or morbidity according to the etiology of the stenosis. The median follow-up duration in this study was 14 months. Conclusions EUS-guided Wirsungo-gastric/duodenal anastomosis is a feasible, minimally invasive, safe, and relatively effective procedure. The rates of technical success, clinical success, and complications were not different between patients with PO and CP stenosis. However, the follow-up period was too short to assess recurrent symptoms in these patients.
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Lesmana CRA, Paramitha MS, Gani RA. Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach? World J Gastrointest Surg 2021; 13:537-547. [PMID: 34194612 PMCID: PMC8223705 DOI: 10.4240/wjgs.v13.i6.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology, as they would sometimes require multi-approach interventional procedures. Recently, therapeutic interventional endoscopic ultrasound (EUS) has emerged as a potential alternative to surgical or percutaneous approaches. Unfortunately, considering the high cost of EUS, lack of facility and expertise, most gastroenterologists still often refer cases to undergo surgical interventions without contemplating the possibility of utilizing EUS first. EUS-guided biliary drainage has become one of the best choices for establishing access to biliary system, given the clear visualization of pancreas, gallbladder, and common bile duct. Although there are still only a few studies which directly compare EUS-guided and surgical approaches for biliary drainage, current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and re-intervention rates, with similarly high technical and clinical success rates compared to percutaneous and surgical approaches, especially in patients with history of failed endoscopic retrograde cholangiopancreatography attempt. Comparable success rates with shorter length of hospital stay between endoscopic and surgical approaches have also been exhibited for pancreatic pseudocysts and walled-off necrosis. Recent findings about the progress of EUS approach in gastroenterostomy/jejunostomy also indicated a promising potential of EUS, as a less invasive approach, for managing gastric outlet obstruction.
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Affiliation(s)
- Cosmas Rinaldi Adithya Lesmana
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta 10430, Indonesia
- Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta 12950, Indonesia
| | - Maria Satya Paramitha
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta 10430, Indonesia
| | - Rino Alvani Gani
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta 10430, Indonesia
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Li R, Veltzke-Schlieker W, Adler A, Ismail M, Badakhshi H, Zorron R. Intragastric Single-Port Surgery: An Innovative and Multipurpose Technique for the Therapy of Upper Digestive Tract Lesions. Surg Innov 2021; 29:56-65. [PMID: 33914655 DOI: 10.1177/15533506211015386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Endoscopic treatment can represent a technical challenge for several special situations, such as resecting gastric tumors with larger size or in unfavorable sites and performing endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y gastric bypass (RYGB). This study aims to describe an innovative and multipurpose technique, intragastric single-port surgery (IGS), which can be applied for abovementioned special situations and for assessing its safety, feasibility, and efficacy. Methods: IGS technique was performed through a 2-3 cm skin incision, where the stomach wall is exteriorized and fixed to the skin. The single-port device is inserted and intragastric access is gained for laparoscopic or endoscopic instruments. Three purposes of IGS were performed: (1). gastric intraluminal lesions resection; (2). to perform ERCP after RYGB; and (3). revision of pancreaticogastric anastomosis after pylorus-preserving pancreaticoduodenectomy. Results: IGS was performed successfully in 20 patients. Ten patients underwent gastric intraluminal lesion resection, mostly for gastric gastrointestinal stromal tumors (n = 7, 70%); all pathological specimens were with negative margin, mean operation time was 102.3 ± 43.5 minutes, and mean postoperative hospital stay was 4.6 ± 1.5 days. Nine patients underwent ERCP after RYGB, cleaning of the bile duct was successful in all patients (100%), and mean operation time and mean postoperative hospital stay were 140.6 ± 46.3 minutes and 4.4 ± 2.6 days, respectively. One patient underwent pancreaticogastric anastomosis revision. There were no mortalities in our series. Conclusions: IGS is a safe, feasible, and effective technique for gastric intraluminal lesion resection and for performing ERCP after RYGB, while it has the potential for other future applications.
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Affiliation(s)
- Renjie Li
- Center for Bariatric and Metabolic Surgery, 14959Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
- Department of Clinical Radiation Oncology, 14959Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Wilfried Veltzke-Schlieker
- Division Interdisciplinary Endoscopy, Department for Hepatology and Gastroenterology, Campus Virchow Klinikum, 72217Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Adler
- Division Interdisciplinary Endoscopy, Department for Hepatology and Gastroenterology, Campus Virchow Klinikum, 72217Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mahmoud Ismail
- Department of Thoracic Surgery, 14959Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, 14959Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Ricardo Zorron
- Center for Bariatric and Metabolic Surgery, 14959Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
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