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      Endoscopic Nasopancreatic Drainage Contributes to Early Resolution of Postgastrectomy Gastropancreatic Fistula

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          Abstract

          A 76-year-old man experienced abdominal pain 43 days after gastric cancer resection. Computed tomography revealed a gastric wall defect extending to the pancreas, and endoscopic retrograde pancreatography revealed a gastropancreatic fistula. Afterward, a nasopancreatic duct drainage tube was inserted. Seven days later, no leakage of the contrast medium from the duct was observed, and the patient was discharged 22 days after endoscopic nasopancreatic duct drainage. Endoscopic nasopancreatic duct drainage prevents pancreatic juice leakage and promotes gastric ulcer healing.

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          Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement.

          T Noone, Radu Tutuian, Shyam Varadarajulu … (2005)
          The aim of this study was to identify predictors of outcome for pancreatic duct (PD) disruption managed by endoscopic transpapillary stent insertion. An endoscopy database was used to identify patients with PD disruption, defined as extravasation of contrast from the PD during ERCP. Data collected included demographic information, the results of imaging studies, management before endoscopic intervention, and outcomes after stent placement. Stents typically were exchanged at intervals of 6 to 8 weeks. Success was defined as clinical and pancreatographic resolution of the PD disruption. Ninety-seven consecutive patients (34 women, 63 men; mean age, 53.7 [12.3] years) with PD disruption seen from 1995 to 2002 were identified. Causes of the disruption were the following: chronic pancreatitis (47), acute pancreatitis (44), operative injury (4), and trauma (2). Transpapillary PD stent insertion was technically successful in 92 (95%) patients; two underwent a combined cystenterostomy. The median duration of stent placement was 58 days (range 4-640 days). The outcome of stent insertion was successful in 52 patients (55%), unsuccessful in 32 (36%), and indeterminate in 8 (9%). On univariate analysis, a partially disrupted PD (p < 0.001), a disruption in the body of the pancreas (p = 0.04), a stent positioned to bridge the disruption (p < 0.001), and a longer duration of stent therapy (p = 0.03) were associated with a successful outcome. On multivariable logistic regression, only a partially disrupted duct and a stent bridging the disruption correlated with a successful outcome. Complications occurred in 6 patients. Successful resolution of PD disruption by transpapillary stent insertion depends on the type of disruption and the ability to bridge the disrupted duct with a stent.
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            "Pancreas-Compressionless Gastrectomy": A Novel Laparoscopic Approach for Suprapancreatic Lymph Node Dissection.

            Masahiro Tsujiura, Naoki Hiki, Manabu Ohashi … (2017)
            In radical operations for gastric cancer, a balance between the quality of lymph node dissection and safety of surgery must be ensured. During suprapancreatic lymphadenectomy in laparoscopic gastrectomy (LG), an adequate operative field should be safely and effectively established to reduce pancreas-related complications. We present a novel approach that avoids direct compression of the pancreas in LG and describe the surgical outcomes of this method.
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              Postoperative pancreatic fistula after gastrectomy for gastric cancer

              Marie Washio, Keishi Yamashita, Masahiro Niihara … (2020)
              Abstract Postoperative pancreatic fistula is one of the most severe complications after gastric cancer surgery, and can cause critical patient conditions leading to surgery‐related death. Fortunately, the incidence of postoperative pancreatic fistula after gastrectomy seems to be decreasing with changes in operative procedures. The rate was reported at about 30% after open gastrectomy with Appleby's method in 1997, but lately has improved below 1% for robotic gastrectomy in 2019. For the diagnosis of postoperative pancreatic fistula, drain amylase concentration has been demonstrated to be beneficial and some reports have proposed the optimal cut‐off values of drain amylase to predict major postoperative pancreatic fistula. There have been many reports identifying risk factors for postoperative pancreatic fistula, including overweight patients, pancreatic anatomy, blunt trauma from compression of the pancreas, and thermal injuries caused by the continuous use of energy devices. And importantly, laparoscopic gastrectomy has been shown to be more often associated with postoperative pancreatic fistula than open gastrectomy in the prospective national clinical database in Japan. Hence, further sophistication of surgical techniques to reduce pancreas compression would have great promise in reducing postoperative pancreatic fistula after laparoscopic gastrectomy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 5 July 2023
                Publication date (Print): 15 February 2024
                Volume: 63
                Issue: 4
                Pages: 487-491
                Affiliations
                [1 ]Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
                [2 ]Department of Gastroenterology, Tokyo Women's Medical University, Japan
                Author notes

                Correspondence to Dr.　Ryogo Minami, minami373323@ 123456gmail.com

                Article
                DOI: 10.2169/internalmedicine.1500-22
                PMC ID: 10937146
                PubMed ID: 37407450
                SO-VID: 14d68f9e-9337-45bf-a3e5-c80c3f36402e
                Copyright © Copyright © 2024 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 22 December 2022
                Date accepted : 7 May 2023
                Categories
                Subject: Case Report

                Keywords: endoscopic nasopancreatic drainage,pancreatic fistula
                Data availability:
                Keywords: endoscopic nasopancreatic drainage, pancreatic fistula

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