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Sho Hasegawa,Shinsuke Koshita,Yoshihide Kanno,Takahisa Ogawa,Toshitaka Sakai,Hiroaki Kusunose,Kensuke Kubota,Atsushi Nakajima,Yutaka Noda,Kei Ito 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because theseverity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile ductstones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of theseverity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severecholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECMgroup, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rateof worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need forelective EI.
( Kei Saito ),( Yousuke Nakai ),( Hiroyuki Isayama ),( Ryuichi Yamamoto ),( Kazumichi Kawakubo ),( Yuzo Kodama ),( Akio Katanuma ),( Atsushi Kanno ),( Masahiro Itonaga ),( Kazuhiko Koike ) 대한소화기학회 2021 Gut and Liver Vol.15 No.1
Background/Aims: The aim of this study was to evaluate the safety and efficacy of partially covered self-expandable metallic stents (PCSEMS) in patients undergoing neoadjuvant chemo (radio) therapy (NAC) for pancreatic cancer (PC). Methods: This was a prospective multicenter study to evaluate the safety and efficacy of PC-SEMS in patients receiving NAC for resectable and borderline resectable PC. The primary endpoint was the rate of recurrent biliary obstruction (RBO). Results: Twenty-six patients with PC (three with resectable PC and 23 with borderline resectable PC) who underwent NAC at seven Japanese centers were included in the analysis. Both the technical and functional success rates of PCSEMS placement were 100%. Early stent-related complications were observed in three patients (11.5%): mild pancreatitis (n=2) and mild liver abscess (n=1). The median time to surgery or palliation was 4.0 months. Surgical resection was eventually performed in 73.1% of patients, and stent removal during surgery was successful in all patients. RBO was observed in nine patients (34.6%): seven with stent occlusion, one with kinking and one with migration. The RBO rates in resected cases and nonresected cases were 36.8% and 28.6%, respectively. Conclusions: Biliary drainage by PCSEMS was safe and feasible in patients undergoing NAC for resectable and borderline resectable PC. (Gut Liver 2021;15:135-141)