Application of endoscopic retrograde cholangiopancreatography in pancreatic duct injury

doi:10.3877/cma.j.issn.2095-3232.2016.06.008

Abstract

Abstract:

Objective

To investigate the application of endoscopic retrograde cholangiopancreatography (ERCP) in pancreatic duct injury.

Methods

Fourteen patients with pancreatic duct injury who were diagnosed and treated with ERCP in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between August 2006 and February 2014 were retrospectively analyzed. Among them, 9 were males and 6 were females, aged 6-77 years old with a median age of 58 years old. Six patients were diagnosed with closed pancreatic injury. Eight cases were complicated with pancreatic fistula after surgery, 3 of whom underwent distal pancreatectomy and 5 underwent distal pancreatectomy combined with splenectomy. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients diagnosed with closed pancreatic injury underwent ERCP. According to the imaging result and American Association for the Surgery of Trauma (AAST) classification, therapeutic measures such as endoscopic retrograde pancreatic drainage (ERPD), and endoscopic retrograde biliary drainage (ERBD) + ERPD were performed. Patients with pancreatic fistula after surgery received ERCP for diagnosis and drainage therapy. The recovery status and incidence of ERCP-related complications after ERCP diagnosis and treatment were observed.

Results

Six cases were confirmed with closed pancreatic injury by ERCP. According to the AAST classification, 4 cases with grade Ⅲ injury underwent ERPD, and 2 with grade IV injury underwent ERBD + ERPD. Eight cases with pancreatic fistula after surgery were all found with pancreatic duct injury by ERCP and then underwent ERPD. The median healing time of pancreatic fistula after surgery was 16(12-25)d. No severe complication was observed during the treatment of ERCP. All patients were recovered and discharged after ERCP treatment. Biliary and pancreatic duct stents were removed 3 months after discharge.

Conclusions

ERCP has the advantages of safty and minimally invasion for the diagnosis and treatment of pancreatic duct injury.

Key words: Pancreatic ducts, Wounds and injuries, Pancreatic fistula, Cholangiopancreatography, endoscopic retrograde

Jiawei Mei, Mingning Zhao, Wenjie Zhang, Jun Gu, Wenguang Wu, Yingbin Liu, Xuefeng Wang. Application of endoscopic retrograde cholangiopancreatography in pancreatic duct injury[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(06): 376-379.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2016.06.008

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2016/V05/I06/376

References 20

[1]	徐晓玲，孙明军．镜下鼻胰管引流治疗胰瘘三例[J]．中华胰腺病杂志，2008，8(6): 411-412.
[2]	Das R, Papachristou GI, Slivka A, et al. Endotherapy is effective for pancreatic ductal disruption: a dual center experience[J]. Pancreatology, 2016, 16(2): 278-283.
[3]	Bradley EL 3rd, Young PR Jr, Chang MC, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review[J]. Ann Surg, 1998, 227(6): 861-869.
[4]	杨永清，徐峰，黄晓敏，等．闭合性胰腺损伤的诊断和外科治疗[J]．肝胆外科杂志，2010，18(3): 205-207.
[5]	刘允怡，迟天毅．胰腺损伤的诊断和处理[J]．中国实用外科杂志，2002，22(1): 24-26.
[6]	雷若庆，王庆刚，张中文，等．胰腺及十二指肠损伤的处理：在明确的基础上力求简单[J]．肝胆胰外科杂志，2011，23(4): 265-266.
[7]	李盈，陈永亮，严力，等．60例创伤性胰腺损伤的临床诊治分析[J]．解放军医学院学报，2013(11):1152-1154.
[8]	Rogers SJ, Cello JP, Schecter WP. Endoscopic retrograde cholangiopancreatography in patients with pancreatic trauma[J]. J Trauma, 2010, 68(3):538-544.
[9]	Malgras B, Douard R, Siauve N, et al. Management of left pancreatic trauma[J]. Am Surg, 2011, 77(1): 1-9.
[10]	Lin BC, Liu NJ, Fang JF, et al. Long-term results of endoscopic stent in the management of blunt major pancreatic duct injury[J]. Surg Endosc, 2006, 20(10): 1551-1555.
[11]	Klin B, Abu-Kishk I, Jeroukhimov I, et al. Blunt pancreatic trauma in children[J]. Surg Today, 2011, 41(7): 946-954.
[12]	吕海旭，钟翔宇，崔云甫．胰腺创伤的诊断与治疗[J]．世界华人消化杂志，2013，21(19):1817-1822.
[13]	赵铭宁，吴文广，陶怡菁，等．内镜逆行胰胆管造影在闭合性胰腺损伤诊疗中的应用（附10例报告）[J]．中国实用外科杂志，2014，34(6): 552-555.
[14]	白雪巍，陈华，刘杰，等．危重胰腺外伤专科化治疗8例疗效分析[J]．中国实用外科杂志，2015，35(3): 302-307.
[15]	Fu CY, Wu SC, Chen RJ, et al. Blunt pancreatic head hematoma as an infrequent cause of delayed obstructive jaundice[J]. J Emerg Med, 2012, 42(2): e27-29.
[16]	Yalin K, Xiaojun H, Chengli L, et al. Grading-therapeutic strategy for pancreatic injury after blunt abdominal trauma：therapy based on the condition of pancreatic duct and report of 95 cases[J]. Hepatogastroenterology, 2013, 60(126): 1497-1503.
[17]	Debi U, Kaur R, Prasad KK, et al. Pancreatic trauma: a concise review[J]. World J Gastroenterol, 2013, 19(47): 9003-9011.
[18]	Vin Y, Sima CS, Getrajdman GI, et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005[J]. J Am Coll Surg, 2008, 207(4): 490-498.
[19]	Ridolfini MP, Alfieri S, Gourgiotis S, et al. Risk factors associated with pancreatic fistula after distal pancreatectomy,which technique of pancreatic stump closure is more beneficial?[J]. World J Gastroenterol, 2007, 13(38): 5096-5100.
[20]	Reddymasu SC, Pakseresht K, Moloney B, et al. Incidence of pancreatic fistula after distal pancreatectomy and efficacy of endoscopic therapy for its management: results from a tertiary care center[J]. Case Rep Gastroenterol, 2013, 7(2): 332-339.

Please choose a citation manager

Content to export