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Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram,Dhaval Choksi,Aditya Kale,Suprabhat Giri,Biswaranjan Patra,Shobna Bhatia,Akash Shukla 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography(ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendrastent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreaticstrictures with a 6-Fr cystotome. Methods: A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant toconventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricturewith plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae. Results: Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis,with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and onehad a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the mostcommon location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limitingbleeding, whereas another patient developed mild post-ERCP pancreatitis. Conclusions: The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreaticstrictures after the failure of conventional modalities.
Ruchir Patel,Meghraj Ingle,Dhaval Choksi,Prateik Poddar,Vikas Pandey,Prabha Sawant 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.