RESUMO
Pancreatoscopy is an advanced endoscopic technique that allows direct observation of the main pancreatic duct, facilitating both diagnosis and treatment of various pancreatic conditions. It enables biopsies and assessment of lesion malignancy. This procedure is performed under deep sedation or anesthesia, with non-steroidal anti- inflammatory drugs recommended for prophylaxis. It is primarily used in diagnosing pancreatic duct strictures and intraductal papillary mucinous neoplasms. Within treatment, its utility is highlighted in intraductal lithotripsy, especially in cases of chronic pancreatitis. The most common adverse effect is acute post-procedural pancreatitis, though estimated in less than 5% of cases. Proper technique, saline administration control, and placement of stents at the end of procedure help minimize complications. Despite being reserved as second-line therapy for pancreatic lithiasis, it offers several advantages over traditional techniques, and it is anticipated that with some advancements in the future, it will become a first-line therapeutic option.
La pancreatoscopia es una técnica endoscópica que permite la observación directa del conducto pancreático prin- cipal, facilitando tanto el diagnóstico como el tratamiento de diversas afecciones pancreáticas. Permite realizar biopsias y evaluar la malignidad de las lesiones. Este procedimiento se realiza bajo sedación profunda o anestesia, y se recomienda la administración de antiinflamatorios no esteroidales en forma de profilaxis. Se utiliza princi- palmente en el diagnóstico de estenosis del conducto pancreático y neoplasias mucinosas papilares intraductales. En el tratamiento, se destaca su utilidad en la litotricia intraductal, especialmente en casos de pancreatitis crónica. El efecto adverso más común es la pancreatitis aguda posprocedimental, aunque se estima en menos del 5% de los casos. Una adecuada técnica, control del suero y la colocación de prótesis al final del procedimiento ayudan a minimizar las complicaciones. A pesar de reservarse como segunda línea en el tratamiento de litiasis pancreáti- cas, presenta diversas ventajas sobre técnicas tradicionales, y se espera que con algunos avances en un futuro se convierta en una opción de primera línea terapéutica.
Assuntos
Humanos , Pancreatopatias/terapia , Ductos Pancreáticos/cirurgia , Endoscopia do Sistema Digestório/métodos , Ductos Pancreáticos/patologia , Resultado do TratamentoRESUMO
BACKGROUND: To determine the effect of intramuscular administration of Neostigmine® on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain. METHODS: We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine®-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine®. Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine®. RESULTS: Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine® administration in all patients, from 1.84 ± 0.98 to 3.41 ± 1.27 mm in the head, 1.34 ± 0.42 mm to 2.5 ± 0.49 mm in the body and 0.72 ± 0.52 mm to 1.78 ± 0.43 mm in the tail (mean ± SD, P < .0001). Neostigmine® helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine®, and in the fourth patient, Neostigmine® improved visualization of multiple pancreatic duct stenosis. CONCLUSION: Neostigmine®-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.
Assuntos
Pancreatite , Secretina , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adolescente , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neostigmina , Pâncreas/patologia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Pancreatite/patologia , Adulto JovemRESUMO
OBJECTIVE: To compare the efficacy of magnetic resonance cholangiopancreatography (MRCP) with endoscopy retrograde cholangiopancreatography (ERCP) in children for the identification of pancreatic duct variants. STUDY DESIGN: We identified children with a pancreatic duct variant by ERCP and separately queried our MRCP database for similar variants. Patients with a paired ERCP-MRCP were reviewed. Three radiologists blinded to the ERCP and MRCP findings were asked to independently review the MRCP studies and define the pancreatic duct anatomy. These blinded reviewers also graded the magnetic resonance imaging examination quality. RESULTS: Seventy-four pairs of ERCP-MRCP examinations were identified. Pancreas divisum was the most frequent ductal variant encountered (73%). There was fair agreement between the radiology reviewers as to the quality of the magnetic resonance imaging studies (Fleiss Kappa agreement). Concordance of the reviewers with that of the ERCP was moderate for the exact diagnosis, moderate for the presence of pancreas divisum, and fair for agreement on the presence of any duct variant. Concordance among reviewers was moderate for the exact diagnosis, moderate for normal vs abnormal, and substantial for the presence of pancreas divisum. CONCLUSIONS: Diagnostic limitations exist when comparing MRCP with the gold reference standard of ERCP, specifically when assessing for pancreatic duct variants in children.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Criança , Humanos , Imageamento por Ressonância Magnética , Pâncreas/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologiaRESUMO
OBJECTIVES: Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP. METHODS: This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups. RESULTS: In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001). CONCLUSIONS: Per-oral pancreatoscopy-guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/patologia , Cálculos Urinários/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/prevenção & controle , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Urinários/complicaçõesRESUMO
Serous cystadenoma of the pancreas is a common cystic neoplasm typically of benign evolution that rarely communicates with the pancreatic ductal system. We present several images originating from two cases of serous cystadenoma of the pancreas which led to compression and dilatation of Wirsung's duct. These cases suggest that when the diagnosis of pancreatic microcystic lesion is detected, associated, or not associated with a central fibrous scar and a low carcinoembryonic antigen level in the aspirated fluid, the presence of dilatation of Wirsung's duct does not exclude the diagnosis of serous pancreatic cystadenoma.
Assuntos
Cistadenoma Seroso/complicações , Cistadenoma Seroso/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Idoso , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Ductos Pancreáticos/patologiaAssuntos
Ampola Hepatopancreática/patologia , Neoplasias Duodenais/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neurofibromatose 1/complicações , Ductos Pancreáticos/patologia , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias Duodenais/patologia , Neoplasias Duodenais/fisiopatologia , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/fisiopatologia , Tumores Neuroendócrinos/cirurgia , Pancreaticoduodenectomia , Resultado do TratamentoRESUMO
OBJECTIVE: We aimed to evaluate the contribution of acinar-to-ductal metaplasia (ADM) to the accumulation of cells with a ductal phenotype in cultured human exocrine pancreatic tissues and reveal the underlying mechanism. METHODS: We sorted and cultured viable cell populations in human exocrine pancreatic tissues with a flow cytometry-based lineage tracing method to evaluate possible mechanisms of ADM. Cell surface markers, gene expression pattern, and sphere formation assay were used to examine ADM. RESULTS: A large proportion of acinar cells gained CD133 expression during the 2-dimensional culture and showed down-regulation of acinar markers and up-regulation of ductal markers, assuming an ADM phenotype. In a serum-free culture condition, ADM induction was mainly dependent on transforming growth factor ß (TGF-ß) secreted from cultured ductal cells. Human acinar cells when cultured alone for a week in a serum-free condition do not undergo ADM. However, serum may contain other factors besides TGF-ß to induce ADM in human acinar cells. In addition, we found that TGF-ß cannot induce ADM of murine acinar cells. CONCLUSIONS: Ductal cells are the major source of TGF-ß that induces ADM in cultured human exocrine pancreatic tissues. This culture system might be a useful model to investigate the mechanism of ADM in human cells.
Assuntos
Células Acinares/metabolismo , Pâncreas Exócrino/metabolismo , Ductos Pancreáticos/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Células Acinares/patologia , Animais , Células Cultivadas , Citometria de Fluxo , Expressão Gênica , Humanos , Metaplasia , Camundongos , Ductos Pancreáticos/patologia , Comunicação Parácrina , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Técnicas de Cultura de Tecidos , Fator de Crescimento Transformador beta/genéticaRESUMO
Pancreatic lesions can produce metabolic disorders. Light-emitting diode (LED) has been used as a safe and effective phototherapy for cell proliferation and regeneration. We investigate the effects of phototherapy using LED irradiation on the pancreas after the injection of streptozotocin (STZ) to induce experimental diabetes and evaluate that the ß cells can regenerate in the pancreas in an in vivo model and observe its implications on the control of carbohydrate metabolism. Twenty Wistar rats were randomized into three groups: non-diabetic control, diabetic control, and diabetic treated with LED. Except for the non-diabetic control group, all were induced to diabetes type I by streptozotocin injection. Treated groups were irradiated by LED: λ = 805 nm; 40 mW, 22 s; spot diameter 5 mm, spot area 0.196 cm2, 0.88 J that it was applied on pancreas projection area for 5 consecutive days and monitored for 30 days. Diabetic group treated with LED showed regeneration of islets and ducts (p = 0.001) on the pancreas. Intraperitoneal insulin tolerance test showed differences between the diabetic control and diabetic treated groups (p = 0.03). In diabetic control group, the hepatic glycogen content was 296% lower when compared with diabetic treated with LED. Furthermore, in the diabetic control group, the glycogen content of the gastrocnemius muscle was 706% smaller when compared with diabetic treated with LED. This study shows that LED was able to modify morphological and metabolic features and also altered carbohydrate metabolism on irradiated pancreas in experimental model of diabetes.
Assuntos
Metabolismo dos Carboidratos/efeitos da radiação , Luz , Ductos Pancreáticos/fisiologia , Ductos Pancreáticos/efeitos da radiação , Regeneração/efeitos da radiação , Animais , Glicemia/metabolismo , Peso Corporal , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Experimental/fisiopatologia , Teste de Tolerância a Glucose , Glicogênio/metabolismo , Fígado/metabolismo , Masculino , Camundongos , Músculos/metabolismo , Ductos Pancreáticos/patologia , Ratos Wistar , EstreptozocinaRESUMO
INTRODUCTION: Per-oral pancreatoscopy can be used for both evaluation and treatment of pancreatic duct stones during endoscopic retrograde cholangiopancreatography, evaluating and treating pancreatic duct strictures of indeterminate etiology, and visual inspection and direct biopsy of pancreatic duct mucosa for diagnosis of intraductal papillary mucinous neoplasm (IPMN). We aim to describe the efficacy, safety, and outcomes of pancreatoscopy in a large, multicenter series of patients. MATERIALS AND METHODS: A multicenter retrospective review was conducted of all patients who underwent per-oral pancreatoscopy at 2 large tertiary-care medical centers. Review of relevant medical records, laboratory data, imaging studies, endoscopic procedure notes, telephone follow-up notes, and progress notes was performed. RESULTS: Thirty-three patients underwent 41 pancreatoscopy procedures. Indications included: 20 (48.8%) for diagnosis and treatment of pancreatic duct stones, 16 (39%) for investigation of IPMN, and 5 (12.2%) for evaluation of pancreatic duct strictures.In 20 procedures performed for stone disease, complete pancreatic duct clearance was achieved in 17 of 20 (85%) cases. Strictures were successfully dilated in 5 of 5 (100%) procedures. Direct visualization and biopsy demonstrated IPMN in 11 of 11 (100%) cases. Adverse events occurred in 3 of 41 (7.3%) of procedures, all of which were mild. CONCLUSIONS: In this large series, we demonstrate that in patients with difficult to manage stone disease, strictures and possible malignant ductal pathology, pancreatoscopy is an effective and safe tool that can facilitate both diagnosis and effective therapy. Adverse events in our study were mild and within acceptable limits, further demonstrating that this is a safe procedure that should be offered to appropriate patients.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia do Sistema Digestório/métodos , Pancreatopatias/diagnóstico , Ductos Pancreáticos/patologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Constrição Patológica/diagnóstico , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/patologia , Pancreatopatias/terapia , Neoplasias Pancreáticas/diagnóstico , Estudos Retrospectivos , Adulto JovemRESUMO
RhoGDI proteins have been implicated in several human cancers; changes in their expression levels have shown pro- or anti-tumorigenic effects. Pancreatic Ductal Adenocarcinoma (PDAC) is a complex pathology, with poor prognosis, and most patients die shortly after diagnosis. Efforts have been focused on understanding the role of RhoGDI's in PDAC, specially, RhoGDI1 and RhoGDI2. However, the role of RhoGDI3 has not been studied in relation to cancer or to PDAC. Here, we characterized the expression and functionality of RhoGDI3 and its target GTPases, RhoG and RhoB in pancreatic cell lines from both normal pancreatic tissue and tissue in late stages of PDAC, and compared them to human biopsies. Through immunofluorescences, pulldown assays and subcellular fractionation, we found a reduction in RhoGDI3 expression in the late stages of PDAC, and this reduction correlates with tumor progression and aggressiveness. Despite the reduction in the expression of RhoGDI3 in PDAC, we found that RhoB was underexpressed while RhoG was overexpressed, suggesting that cancerous cells preserve their capacity to activate this pathway, thus these cells may be more eager to response to the stimuli needed to proliferate and become invasive unlike normal cells. Surprisingly, we found nuclear localization of RhoGDI3 in non-cancerous pancreatic cell line and normal pancreatic tissue biopsies, which could open the possibility of novel nuclear functions for this protein, impacting gene expression regulation and cellular homeostasis.