EUS胰腺会合治疗胰十二指肠切除术后胰瘘的ERCP失败

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.002

Kambiz Kadkhodayan MD , Shayan Irani MD

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引用次数: 0

摘要

背景和目的手术后胰瘘（POPF）是胰腺手术后高度病态的不良事件，发生率高达25%至30%的患者。临床显著的popf （B级和C级）通常需要经皮和内窥镜介入治疗。替代策略，如eus引导交会是有用的，当大胰空肠吻合术破裂阻止常规内镜逆行胰造影。方法我们报告了连续3例Whipple手术后出现有临床意义的popf的患者，这些患者在经皮和常规内镜下逆行胰腺造影引流失败。患者的中位年龄为62岁，中位体重指数为40，中位胰管直径为2mm。结果所有病例均行超声引导下胰腺交会。从手术到eus引导交会的中位时间为28天。经皮引流管在术后中位数20天后被移除。平均支架停留时间为123.6天。没有早期或延迟的不良事件。中位随访33个月，无复发记录。结论超声引导下胰腺交会治疗对传统经皮内镜治疗无效的popf患者是一种可行的抢救策略。需要进一步的研究。

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EUS pancreatic rendezvous to rescue failed ERCP for postoperative pancreatic fistula after pancreaticoduodenectomy

Background and Aims

Postoperative pancreatic fistula (POPF) is a highly morbid adverse event after pancreatic surgery that occurs in up to 25% to 30% of patients. Clinically significant POPFs (grades B and C) often require a step-up approach with percutaneous and endoscopic interventions. Alternative strategies such as EUS-guided rendezvous are helpful when large pancreatojejunostomy dehiscence prevents conventional endoscopic retrograde pancreatography.

Methods

We present a series of 3 consecutive patients with clinically significant POPFs after the Whipple procedure in whom there was an unsuccessful percutaneous and conventional endoscopic retrograde pancreatography drainage. The median age of the patients was 62 years, their median body mass index was 40, and median pancreatic duct diameter was 2 mm.

Results

EUS-guided pancreatic rendezvous was performed in all cases. The median time from surgery to EUS-guided rendezvous was 28 days. Percutaneous drains were removed after a median of 20 days postprocedure. The mean stent dwell time was 123.6 days. There were no early or delayed adverse events. On median follow-up of 33 months, there were no recurrences recorded.

Conclusions

EUS-guided pancreatic rendezvous is a viable rescue strategy for patients with POPFs who do not respond to traditional percutaneous and endoscopic therapy. Further studies are needed.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.