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Myunghwan Kim - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of endoscopic ultrasound guided pancreatic duct drainage using a fully covered self expandable metal stent for pancreaticojejunal anastomosis stricture
2020Co-Authors: Do Hyun Park, Sung Koo Lee, Tae Jun Song, Sang Soo Lee, Dongwan Seo, Myunghwan KimAbstract:BACKGROUND AND AIM Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has been proposed for pancreatic duct obstruction after failure of endoscopic retrograde Pancreatography. We evaluate the long-term outcomes of EUS-PD using a fully covered self-expandable metal stent (FCSEMS) for pancreaticojejunal anastomosis (PJA) strictures following Whipple procedures. METHODS Twenty-three patients with PJA strictures underwent EUS-PD according to the findings of EUS-guided pancreatogram and the passage of the guidewire through PJA stricture (complete vs partial stricture) after failure of endoscopic retrograde Pancreatography. Technical and clinical success, adverse events (AEs), and long-term outcomes were assessed. RESULTS Technical and clinical success was achieved in all patients. The complete and partial strictures were 11 and 12, respectively. The direct transanastomotic and transmural plastic stenting in partial PJA stricture was successful in only three patients (13%). Therefore, 20 patients underwent EUS-guided transmural FCSEMS placement during the initial attempt. Early AEs, including abdominal pain (n = 3) and peripancreatic fluid collection (n = 1), occurred in four patients (17.4%). During the follow-up periods (median, 27.2 months; interquartile range [IQR], 18.7-40.6), five patients (21.7%) developed late AEs, including asymptomatic stent fracture at the gastric end (n = 3), asymptomatic stent migration (n = 1), and stent occlusion (n = 1). The total duration of stent placement was 27.2 months (IQR, 18.7-40.6), and the median number of stent revision was 2 (IQR, 1-2). CONCLUSIONS In terms of safety and efficacy, EUS-PD with an FCSEMS showed favorable success and acceptable AEs rate and durable long-term outcomes.
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pancreatic duct in autoimmune pancreatitis intraindividual comparison of magnetic resonance Pancreatography at 1 5 t and 3 0 t
2017Co-Authors: Jin Hee Kim, Jae Ho Byun, Myunghwan Kim, Sung Koo Lee, Song Cheol Kim, Hyoung Jung Kim, Seung Soo Lee, So Yeon Kim, Moongyu LeeAbstract:ObjectiveThe aim of this study was to intraindividually compare magnetic resonance Pancreatography (MRP) image quality at 1.5 T and 3.0 T when demonstrating main pancreatic duct (MPD) abnormalities in patients with autoimmune pancreatitis (AIP).MethodsThirty prospectively enrolled patients with AIP
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diagnostic strategy for differentiating autoimmune pancreatitis from pancreatic cancer is an endoscopic retrograde Pancreatography essential
2012Co-Authors: Jin Hee Kim, Jae Ho Byun, Myunghwan Kim, Sung Koo Lee, Seung Soo Lee, Moongyu Lee, So Jung Lee, Seong Ho Park, Do Hyun Park, Sunghoon MoonAbstract:Abstract OBJECTIVES: The purpose of this study was to determine whether the choice for performance of endoscopic retrograde Pancreatography (ERP) could be tailored to findings on computed tomography (CT) in patients with suspected autoimmune pancreatitis (AIP). METHODS: Eighty-four AIP patients and 73 pathology-proven pancreatic cancer patients from a prospectively maintained database were retrospectively included. Computed tomography and ERP images were reviewed in consensus by 2 blinded radiologists. The diagnostic performance of CT alone and combined use of CT and ERP (CT-ERP) were compared. RESULTS: The area under the receiver operating characteristic curve of CT-ERP was significantly greater than that of CT alone (0.97 vs 0.87, P < 0.001). When patients with AIP were divided into 2 subgroups according to CT features (typical vs atypical), 24 (69%) of 35 AIP patients with atypical CT findings were correctly diagnosed with AIP at CT-ERP and received benefits from additional ERP. Endoscopic retrograde Pancreatography had little added benefit in patients with typical CT findings for AIP (n = 49), because no alternative diagnoses were established after ERP. CONCLUSIONS: In patients with suspected AIP, the decision to perform ERP could be tailored to findings on CT.
Celso Matos - One of the best experts on this subject based on the ideXlab platform.
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chronic pancreatitis evaluation of pancreatic exocrine function with mr Pancreatography after secretin stimulation
2000Co-Authors: Olivier Cappeliez, Myriam Delhaye, Michel Cremer, Jacques Deviere, Olivier Le Moine, Thierry Metens, Nicole Nicaise, Julien Stryuven, Celso MatosAbstract:PURPOSE: To compare duodenal filling seen at magnetic resonance (MR) Pancreatography after secretin stimulation and biochemical parameters determined with the intraductal secretin test (IDST) for evaluation of pancreatic exocrine function. MATERIALS AND METHODS: MR Pancreatography after secretin stimulation and IDST were performed in 41 patients with chronic pancreatitis (group 1) and eight patients with other pancreatic disease (group 2). A control group (group 3, n = 28) underwent MR Pancreatography after secretin stimulation only. MR pancreatograms were acquired before and every 30 seconds for 10 minutes after secretin injection. Duodenal filling was graded from least amount of filling (grade 1) to normal filling (grade 3) on the last MR pancreatogram. Pancreatic exocrine function was determined at IDST. Main pancreatic ductal diameter was compared between groups 1 and 3. RESULTS: All ductal diameters were significantly larger in group 1 (P < .001). The maximal diameter variation after secretin stimula...
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secretin enhanced mr Pancreatography
1999Co-Authors: Celso Matos, Nicole Nicaise, Thierry Metens, M Cremer, Jacques DeviereAbstract:MR cholangioPancreatography has now emerged as a noninvasive diagnostic technique that can replace diagnostic endoscopic retrograde cholangioPancreatography in many instances. Recent technical issues include the use of fast single-shot T2-weighted single-slice projections in combination with a negative oral contrast agent and secretin stimulation for assessment of pancreatic flow dynamics and duodenal filling. Potential clinical applications include the evaluation of patients with recurrent pancreatitis and inconclusive CT examination as well as the evaluation of chronic pancreatitis complications whenever endoscopic treatment is suggested. In combination with cross-sectional MR sequences, secretin-enhanced MR Pancreatography offers the possibility of a comprehensive examination of the pancreas that provides parenchymal, ductal, and functional information within a single diagnostic modality.
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acinar filling during secretin stimulated mr Pancreatography
1998Co-Authors: Celso Matos, Jacques Deviere, Nicole Nicaise, M Cremer, Julien Struyven, Thierry MetensAbstract:OBJECTIVE: The purpose of this study is to report a new sign, "acinar filling," observed on dynamic MR Pancreatography after secretin stimulation in patients with suspected early chronic pancreatitis. CONCLUSION: Acinar filling might reflect tissue hypertension or loss of pancreatic parenchyma compliance or both. This finding is probably an insensitive but specific sign of early chronic pancreatitis.
Sung Koo Lee - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of endoscopic ultrasound guided pancreatic duct drainage using a fully covered self expandable metal stent for pancreaticojejunal anastomosis stricture
2020Co-Authors: Do Hyun Park, Sung Koo Lee, Tae Jun Song, Sang Soo Lee, Dongwan Seo, Myunghwan KimAbstract:BACKGROUND AND AIM Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has been proposed for pancreatic duct obstruction after failure of endoscopic retrograde Pancreatography. We evaluate the long-term outcomes of EUS-PD using a fully covered self-expandable metal stent (FCSEMS) for pancreaticojejunal anastomosis (PJA) strictures following Whipple procedures. METHODS Twenty-three patients with PJA strictures underwent EUS-PD according to the findings of EUS-guided pancreatogram and the passage of the guidewire through PJA stricture (complete vs partial stricture) after failure of endoscopic retrograde Pancreatography. Technical and clinical success, adverse events (AEs), and long-term outcomes were assessed. RESULTS Technical and clinical success was achieved in all patients. The complete and partial strictures were 11 and 12, respectively. The direct transanastomotic and transmural plastic stenting in partial PJA stricture was successful in only three patients (13%). Therefore, 20 patients underwent EUS-guided transmural FCSEMS placement during the initial attempt. Early AEs, including abdominal pain (n = 3) and peripancreatic fluid collection (n = 1), occurred in four patients (17.4%). During the follow-up periods (median, 27.2 months; interquartile range [IQR], 18.7-40.6), five patients (21.7%) developed late AEs, including asymptomatic stent fracture at the gastric end (n = 3), asymptomatic stent migration (n = 1), and stent occlusion (n = 1). The total duration of stent placement was 27.2 months (IQR, 18.7-40.6), and the median number of stent revision was 2 (IQR, 1-2). CONCLUSIONS In terms of safety and efficacy, EUS-PD with an FCSEMS showed favorable success and acceptable AEs rate and durable long-term outcomes.
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pancreatic duct in autoimmune pancreatitis intraindividual comparison of magnetic resonance Pancreatography at 1 5 t and 3 0 t
2017Co-Authors: Jin Hee Kim, Jae Ho Byun, Myunghwan Kim, Sung Koo Lee, Song Cheol Kim, Hyoung Jung Kim, Seung Soo Lee, So Yeon Kim, Moongyu LeeAbstract:ObjectiveThe aim of this study was to intraindividually compare magnetic resonance Pancreatography (MRP) image quality at 1.5 T and 3.0 T when demonstrating main pancreatic duct (MPD) abnormalities in patients with autoimmune pancreatitis (AIP).MethodsThirty prospectively enrolled patients with AIP
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diagnostic strategy for differentiating autoimmune pancreatitis from pancreatic cancer is an endoscopic retrograde Pancreatography essential
2012Co-Authors: Jin Hee Kim, Jae Ho Byun, Myunghwan Kim, Sung Koo Lee, Seung Soo Lee, Moongyu Lee, So Jung Lee, Seong Ho Park, Do Hyun Park, Sunghoon MoonAbstract:Abstract OBJECTIVES: The purpose of this study was to determine whether the choice for performance of endoscopic retrograde Pancreatography (ERP) could be tailored to findings on computed tomography (CT) in patients with suspected autoimmune pancreatitis (AIP). METHODS: Eighty-four AIP patients and 73 pathology-proven pancreatic cancer patients from a prospectively maintained database were retrospectively included. Computed tomography and ERP images were reviewed in consensus by 2 blinded radiologists. The diagnostic performance of CT alone and combined use of CT and ERP (CT-ERP) were compared. RESULTS: The area under the receiver operating characteristic curve of CT-ERP was significantly greater than that of CT alone (0.97 vs 0.87, P < 0.001). When patients with AIP were divided into 2 subgroups according to CT features (typical vs atypical), 24 (69%) of 35 AIP patients with atypical CT findings were correctly diagnosed with AIP at CT-ERP and received benefits from additional ERP. Endoscopic retrograde Pancreatography had little added benefit in patients with typical CT findings for AIP (n = 49), because no alternative diagnoses were established after ERP. CONCLUSIONS: In patients with suspected AIP, the decision to perform ERP could be tailored to findings on CT.
Christian Partensky - One of the best experts on this subject based on the ideXlab platform.
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intraductal papillary and mucinous tumors of the pancreas accuracy of preoperative computed tomography endoscopic retrograde Pancreatography and endoscopic ultrasonography and long term outcome in a large surgical series
1998Co-Authors: Christophe Cellier, E Cuillerier, L Palazzo, Fabienne Rickaert, Jeanfrancois Flejou, Bertrand Napoleon, Daniel Van Gansbeke, Natacha Bely, Philippe Ponsot, Christian PartenskyAbstract:Abstract Background : Few data are available on the accuracy of preoperative imaging or on long-term outcome after surgery for intraductal papillary and mucinous tumors of the pancreas. The aims of this study were to assess the following: (1) the accuracy of preoperative computed tomography, endoscopic retrograde Pancreatography, and endoscopic ultrasonography for determination of tumor invasion and pancreatic extension as compared with surgical findings; (2) the long-term outcome after surgery. Methods : Forty-seven patients who underwent surgery between 1980 and 1995 for pathologically diagnosed intraductal papillary and mucinous tumors were included in this study. The findings of available computed tomography (n = 25), endoscopic retrograde Pancreatography (n = 29), and endoscopic ultrasonography (n = 21) were reviewed by experienced clinicians blinded to pathologic diagnosis to assess tumor invasion and pancreatic extension. Pathologic specimens were reviewed by experienced pathologists. Postoperative follow-up data were analyzed. Results : Histologic features of invasive carcinoma were found in 43% of patients, severe dysplasia in 21%, and mild or moderate dysplasia in 36%. The overall accuracy of computed tomography, endoscopic retrograde Pancreatography, and endoscopic ultrasonography in distinguishing between invasive and noninvasive tumors were, respectively, 76%, 79%, and 76%. The overall 3-year disease-free survival rate was 63%, but it was 21% among patients with invasive carcinoma at surgery ( p Conclusions : This study emphasizes the need for early surgical resection in patients with suspected intraductal papillary and mucinous tumors of the pancreas because of the high frequency of invasive carcinoma and the inadequacy of preoperative imaging for assessing malignancy. (Gastrointestinal Endosc 1998;47:42-9.)
Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.
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therapeutic eus assisted endoscopic retrograde Pancreatography after failed pancreatic duct cannulation at ercp
2010Co-Authors: Olga Barkay, Stuart Sherman, Lee Mchenry, Byung Moo Yoo, Evan L Fogel, James L Watkins, John M Dewitt, Mohammad A Alhaddad, Glen A LehmanAbstract:Background Cannulation of the pancreatic duct (PD) during endoscopic retrograde Pancreatography (ERP) can fail even in experienced hands. A technique for therapeutic EUS-assisted rendezvous ERP has been described in a few case reports. Objective To investigate the efficacy and safety of therapeutic EUS-assisted ERP. Design Retrospective study. Setting Tertiary-care medical center. Patients This study involved 21 patients after failed ERP. Intervention EUS-guided transgastric Pancreatography by using a mixture of contrast media and methylene blue was attempted. If that was successful, ERP was attempted by using methylene blue flow as an indicator of the PD orifice or by a rendezvous technique using a wire passed into the PD and the small bowel through the EUS needle. Main Outcome Measurements Technical success rate and complications. Results The PD was of a normal diameter in 7 patients and was dilated in 14 patients. EUS-guided Pancreatography was successfully done in all patients with a dilated PD but only in 4 of 7 patients (57%) with normal-diameter PDs. In 6 patients, ERP was successfully performed by using methylene blue flow as an indicator of the PD orifice. The rendezvous technique was successful in 4 of 12 cases (33%), and reasons for failure were either a tight stricture (n = 5) or a suboptimal angle of EUS needle insertion (n = 3). Overall, EUS-assisted ERP was successful in 10 of 21 patients (48%). Complications included peripancreatic abscess in 1 patient and mild pancreatitis in 1 patient. Limitations Retrospective study, small sample size. Conclusion EUS-assisted ERP is a complex procedure that can provide access to the PD in selected cases after failed standard ERP.
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pancreatits after endoscopic retrograde cholangio Pancreatography
2007Co-Authors: Ayman Abdel M Aziz, Glen A LehmanAbstract:Pancreatitis is the most common complication after endoscopic retrograde cholangio-Pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving non-selected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.
