He YG, Li J, Peng XH, Wu J, Xie MX, Tang YC, Zheng L, Huang XB. Sequential therapy with combined trans-papillary endoscopic naso-pancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts. World J Clin Cases 2021; 9(22): 6254-6267 [PMID: 34434992 DOI: 10.12998/wjcc.v9.i22.6254]
Corresponding Author of This Article
Xiao-Bing Huang, MD, PhD, Professor, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. 1038915320@qq.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
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/
Yong-Gang He, Jing Li, Xue-Hui Peng, Jing Wu, Yi-Chen Tang, Lu Zheng, Xiao-Bing Huang, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Ming-Xun Xie, Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Author contributions: He YG, Huang XB and Li J contributed to conception and design of the study, and drafted the manuscript; Peng XH, Wu J, and Tang YC contributed to analysis and interpretation of the data and revised the manuscript; Xie MX and Zheng L participated in clinical treatment and the literature research; all authors read and approved the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 81672902; and the Hospital Research Fund (General Project) from The Second Affiliated Hospital of Army Medical University, No. 2016YLC18 and No. 2019XLC2006.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the Second Affiliated Hospital of Army Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest to disclose.
Data sharing statement: The authors declare that all the data have been provided in the article, and there are no additional data.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Bing Huang, MD, PhD, Professor, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. 1038915320@qq.com
Received: April 2, 2021 Peer-review started: April 2, 2021 First decision: April 28, 2021 Revised: May 7, 2021 Accepted: June 3, 2021 Article in press: June 3, 2021 Published online: August 6, 2021 Processing time: 116 Days and 11.5 Hours
ARTICLE HIGHLIGHTS
Research background
Endoscopic retrograde pancreatic drainage (ERPD) and stent implantation is associated with a high recurrence rate and infection rate.
Research motivation
A two-step trans-papillary procedure involving endoscopic naso-pancreatic drainage (ENPD) and ERPD sequential therapy for pancreatic pseudocysts may reduce the infection-related complications seen with single stent implantation, address concerns related to tube blockage, and reduce patient discomfort due to long-term single naso-pancreatic duct implantation.
Research objectives
To manage pancreatic pseudocysts by sequential therapy with ENPD combined with ERPD and evaluate the treatment outcome.
Research methods
One hundred and fifty-two cases of pancreatic pseudocysts were intubated via the duodenal papilla, and 92 cases involved pancreatic duct stent implantation and 60 cases involved sequential therapy with ENPD combined with ERPD. The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups.
Research results
The incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). The reoperation rate was also significantly higher in the ERPD group (7 cases) than in the two-step procedure group (0 cases). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).
Research conclusions
Two-step sequential therapy with ENPD combined with ERPD is safe and effective in patients with pancreatic pseudocysts.
Research perspectives
The sequential therapywith trans-papillary ENPD combined with ERPD for pancreatic pseudocysts meets the physiological requirements and avoids complications, such as infection and bleeding of the cyst. Compared with pancreatic duct stenting, it facilitates postoperative observation and makes rinsing and unblocking easier after duct blockage, which greatly reduces the risk of infection and shortens the treatment time of pancreatic pseudocysts with a low recurrence rate, effectively reducing the total treatment costs. The two-step procedure can be widely used in clinical practice with low requirements for devices; thus, this sequential therapy is particularly suitable for hospitals at all levels.
