Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis
Pancreatobiliary fistulas associated with intraductal papillary mucinous neoplasms (IPMN) often develop obstructive jaundice and cholangitis; thus, early diagnosis is important. However, computed tomography and cholangiography, the current methods for detecting pancreatobiliary fistulas, are not alw...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2016-03-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-102956 |
| _version_ | 1828487177571401728 |
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| author | Mitsuhito Koizumi Teru Kumagi Taira Kuroda Nobuaki Azemoto Hirofumi Yamanishi Yoshinori Ohno Tomoyuki Yokota Hironori Ochi Kazuhiro Tange Yoshiou Ikeda Yoichi Hiasa |
| author_facet | Mitsuhito Koizumi Teru Kumagi Taira Kuroda Nobuaki Azemoto Hirofumi Yamanishi Yoshinori Ohno Tomoyuki Yokota Hironori Ochi Kazuhiro Tange Yoshiou Ikeda Yoichi Hiasa |
| author_sort | Mitsuhito Koizumi |
| collection | DOAJ |
| description | Pancreatobiliary fistulas associated with intraductal papillary mucinous neoplasms (IPMN) often develop obstructive jaundice and cholangitis; thus, early diagnosis is important. However, computed tomography and cholangiography, the current methods for detecting pancreatobiliary fistulas, are not always effective. We previously reported a case of IPMN-associated pancreatobiliary fistula and proposed a potential new diagnostic marker: the “pig-nose” appearance of the duodenal papilla, which results from dilated pancreatic and bile ducts and can be visualized via endoscopy. In this study, we report another three cases of IPMN-associated pancreatobiliary fistulas detected by a different technology, intraductal ultrasonography (IDUS). As with our previously reported case, we confirmed the utility of the “pig-nose” appearance and IDUS in the diagnosis of IPMN-associated pancreatobiliary fistulas. In addition, we found it difficult to manage biliary obstruction that resulted from the flow of mucinous material through pancreatobiliary fistulas. The obstruction was treated with endoscopic nasal biliary drainage (ENBD), but this was not always successful. In two of our cases, additional treatment with a large diameter fully covered metal stent failed to improve jaundice. Therefore, we conclude that standard endoscopic stenting may not be effective, and that alternative endoscopic methods or surgery may be necessary. |
| first_indexed | 2024-12-11T09:46:07Z |
| format | Article |
| id | doaj.art-c4ab0fe65e5541ef9154c2b28216206b |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-11T09:46:07Z |
| publishDate | 2016-03-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-c4ab0fe65e5541ef9154c2b28216206b2022-12-22T01:12:33ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362016-03-010404E446E45010.1055/s-0042-102956Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosisMitsuhito Koizumi0Teru Kumagi1Taira Kuroda2Nobuaki Azemoto3Hirofumi Yamanishi4Yoshinori Ohno5Tomoyuki Yokota6Hironori Ochi7Kazuhiro Tange8Yoshiou Ikeda9Yoichi Hiasa10Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanCenter for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, JapanCenter for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, JapanEndoscopy Center, Ehime University Hospital, Ehime, JapanGastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, JapanPancreatobiliary fistulas associated with intraductal papillary mucinous neoplasms (IPMN) often develop obstructive jaundice and cholangitis; thus, early diagnosis is important. However, computed tomography and cholangiography, the current methods for detecting pancreatobiliary fistulas, are not always effective. We previously reported a case of IPMN-associated pancreatobiliary fistula and proposed a potential new diagnostic marker: the “pig-nose” appearance of the duodenal papilla, which results from dilated pancreatic and bile ducts and can be visualized via endoscopy. In this study, we report another three cases of IPMN-associated pancreatobiliary fistulas detected by a different technology, intraductal ultrasonography (IDUS). As with our previously reported case, we confirmed the utility of the “pig-nose” appearance and IDUS in the diagnosis of IPMN-associated pancreatobiliary fistulas. In addition, we found it difficult to manage biliary obstruction that resulted from the flow of mucinous material through pancreatobiliary fistulas. The obstruction was treated with endoscopic nasal biliary drainage (ENBD), but this was not always successful. In two of our cases, additional treatment with a large diameter fully covered metal stent failed to improve jaundice. Therefore, we conclude that standard endoscopic stenting may not be effective, and that alternative endoscopic methods or surgery may be necessary.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-102956 |
| spellingShingle | Mitsuhito Koizumi Teru Kumagi Taira Kuroda Nobuaki Azemoto Hirofumi Yamanishi Yoshinori Ohno Tomoyuki Yokota Hironori Ochi Kazuhiro Tange Yoshiou Ikeda Yoichi Hiasa Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis Endoscopy International Open |
| title | Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis |
| title_full | Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis |
| title_fullStr | Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis |
| title_full_unstemmed | Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis |
| title_short | Difficulty in management of intraductal papillary mucinous neoplasm-associated pancreatobiliary fistulas and the role of “pig-nose” appearance and intraductal ultrasonography in diagnosis |
| title_sort | difficulty in management of intraductal papillary mucinous neoplasm associated pancreatobiliary fistulas and the role of pig nose appearance and intraductal ultrasonography in diagnosis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-102956 |
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