Kim KH, Park CH, Cho E, Lee Y. Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent: A case report. World J Clin Cases 2024; 12(9): 1677-1684 [PMID: 38576743 DOI: 10.12998/wjcc.v12.i9.1677]
Corresponding Author of This Article
Chang Hwan Park, MD, PhD, Professor, Department of Gastroenterology, Chonnam National University Hospital, No. 42 Jebong-ro Donggu, Gwangju 61469, South Korea. p1052ccy@hanmail.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2024; 12(9): 1677-1684 Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1677
Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent: A case report
Ki-Hyun Kim, Chang Hwan Park, Eunae Cho, Yohan Lee
Ki-Hyun Kim, Eunae Cho, Yohan Lee, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
Chang Hwan Park, Department of Gastroenterology, Chonnam National University Hospital, Gwangju 61469, South Korea
Author contributions: Kim KH, Cho E, Lee Y designed the research study; Kim KH and Park CH analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and all accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Hwan Park, MD, PhD, Professor, Department of Gastroenterology, Chonnam National University Hospital, No. 42 Jebong-ro Donggu, Gwangju 61469, South Korea. p1052ccy@hanmail.net
Received: December 4, 2023 Peer-review started: December 4, 2023 First decision: January 9, 2024 Revised: February 3, 2024 Accepted: March 5, 2024 Article in press: March 5, 2024 Published online: March 26, 2024
Abstract
BACKGROUND
Pancreatic ductal leaks complicated by endoscopic ultrasonography-guided tissue sampling (EUS-TS) can manifest as acute pancreatitis.
CASE SUMMARY
A 63-year-old man presented with persistent abdominal pain and weight loss. Diagnosis: Laboratory findings revealed elevated carbohydrate antigen 19-9 (5920 U/mL) and carcinoembryonic antigen (23.7 ng/mL) levels. Magnetic resonance imaging of the pancreas revealed an approximately 3 cm ill-defined space-occupying lesion in the inferior aspect of the head, with severe encasement of the superior mesenteric artery. Pancreatic ductal adenocarcinoma was confirmed after pathological examination of specimens obtained by EUS-TS using the fanning method. Interventions and outcomes: The following day, the patient experienced severe abdominal pain with high amylase (265 U/L) and lipase (1173 U/L) levels. Computed tomography of the abdomen revealed edematous wall thickening of the second portion of the duodenum with adjacent fluid collections and a suspicious leak from either the distal common bile duct or the main pancreatic duct in the head. Endoscopic retrograde cholangiopancreatography revealed dye leakage in the head of the main pancreatic duct. Therefore, a 5F 7 cm linear plastic stent was deployed into the pancreatic duct to divert the pancreatic juice. The patient’s abdominal pain improved immediately after pancreatic stent insertion, and amylase and lipase levels normalized within a week. Neoadjuvant chemotherapy was then initiated.
CONCLUSION
Using the fanning method in EUS-TS can inadvertently cause damage to the pancreatic duct and may lead to clinically significant pancreatitis. Placing a pancreatic stent may immediately resolve acute pancreatitis and shorten the waiting time for curative therapy. When using the fanning method during EUS-TS, ductal structures should be excluded to prevent pancreatic ductal leakage.
Core Tip: Endoscopic ultrasound guided tissue sampling is a crucial procedure for histological diagnosis of pancreatic lesions, but it may occasionally be accompanied by unforeseen complications. The Fanning method is a technique that can enhance diagnostic accuracy, but it also carries the risk of unintended ductal injury. Here, we report a case where the use of the Fanning method during endoscopic ultrasound guided tissue sampling resulted in leakage of the pancreatic duct. We successfully managed this complication by performing pancreatic duct stent via endoscopic retrograde cholangiopancreatography.
