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Expanding endoscopic interventions for pancreatic pseudocyst and walled-off necrosis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Recently, several endoscopists have described the usefulness of the endoscopic ultrasonography (EUS)-guided, single transluminal gateway technique (SGT) using transmural placement of single or multiple plastic stents or metal stents for a pancreatic pseudocyst (PC) and walled-off necrosis (WON). Moreover, the uses of the multiple transluminal gateway technique (MTGT) and single transluminal gateway transcystic multiple drainages (SGTMD) for complicated pancreatic walled-off necrosis have recently been reported. The aim of this study is to evaluate retrospectively the feasibility and efficacy of endotherapy for the treatment of complicated PC and WON cases.

Methods

Eighty-nine patients with a PC (n = 14) and WON (n = 75) were treated under EUS guidance.

Results

In a total of 89 cases using SGT in combination with MTGT or SGTMD, the present study showed a technical success rate of 100 %, a final clinical success rate of 97.8 %, an adverse event during procedure rate of 0 %, an early adverse event rate of 12.4 %, and a mortality rate of 2.2 %.

Conclusions

Even complicated WON cases can be treated using combination endotherapies, although a surgical approach as well as a percutaneous approach should be considered in the cases refractory to endoscopic therapies.

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Abbreviations

EUS:

Endoscopic ultrasonography

SEMS:

Self-expandable metal stent

PCD:

Pancreatic pseudocyst drainage

DEN:

Direct endoscopic necrosectomy

SGT:

Single transluminal gateway technique

MTGT:

Multiple transluminal gateway technique

SGTMD:

Single transluminal gateway transcystic multiple drainages

ERP:

Endoscopic retrograde pancreatography

PC:

Pancreatic pseudocyst

WON:

Walled-off necrosis

AE:

Adverse event

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Acknowledgments

The authors are indebted to Maya Vardaman and Associate Professor Edward Barroga of the Department of International Medical Communications of Tokyo Medical University for the editorial review of the English manuscript. We are grateful to Dr. Todd. H. Baron of the Mayo Clinic, Rochester, Minnesota, USA, for his valuable editing suggestions.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Shuntaro Mukai, Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Reina Tanaka, Junko Umeda, Ryosuke Tonozuka, Mitsuyoshi Honjo, Takuji Gotoda & Fuminori Moriyasu

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  1. Shuntaro Mukai
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  2. Takao Itoi
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  3. Atsushi Sofuni
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  4. Fumihide Itokawa
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  5. Toshio Kurihara
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  13. Mitsuyoshi Honjo
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  14. Takuji Gotoda
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  15. Fuminori Moriyasu
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Corresponding author

Correspondence to Shuntaro Mukai.

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Mukai, S., Itoi, T., Sofuni, A. et al. Expanding endoscopic interventions for pancreatic pseudocyst and walled-off necrosis. J Gastroenterol 50, 211–220 (2015). https://doi.org/10.1007/s00535-014-0957-8

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  • DOI: https://doi.org/10.1007/s00535-014-0957-8

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