Thuraisingam, A.I.; Smart, H.L.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA75
Academic Journal
Background and Aims: Therapeutic pancreatic endoscopy is a specialised technique used to treat a range of pancreatic disease. There are few prospective, randomised studies of pancreatic endotherapy and most data are derived from uncontrolled series. We assessed current practice relating to pancreatic endotherapy at ERCP in a regional teaching hospital and examined our procedural outcomes. Methods: A retrospective case note audit was undertaken of all patients, over a three and a half year period, in whom therapeutic endoscopy was attempted or performed. Data were collected regarding patient demographics; endoscopists; indications; use of preprocedural imaging; procedure performed; success rate; 30 day complication rate; and 1 year outcome. Results: Sixty-three out of 1906 ERCPs (3.3%), performed in this period, involved pancreatic endotherapy. These were undertaken in 32 patients by 5 principal endoscopists. There were 21 men and 11 women with a mean age of 49 years (range 11-74 years). Incomplete data were available for one patient. Imaging in the 3 months prior to endotherapy included: 43 CT scans; 27 ultrasounds; 25 ERCPs; 5 endoluminal ultrasounds; and 2 MRIs. The procedural indications were: 25 for pseudocyst drainage (9 with another indication); 26 for stent change; 8 for pancreatic duct stricture; 7 for pancreaticopleural fistula; 3 for pancreatic ascites; and 3 for pancreatic duct trauma/disruption. Overall 49 of 63 procedures (78%) were completed successfully, with 2 patients having repeated failed procedures. 19 of 32 patients required more than one procedure. Complications included one episode each of pancreatitis, infection, peritonitis, and bleeding. There was no 30 day mortality. 18 of 21 patients followed up for over 1 year were alive. Discussion: Pancreatic endotherapy remains an uncommonly performed specialised procedure. The predominant indicatons in th s series relate to complications of pancreatic ductal disruption in chronic pancreatitis....


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