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Ethanol ablation is an alternative treatment modality for disconnected pancreatic duct syndrome (with video)


 Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China

Date of Submission09-Nov-2021
Date of Acceptance15-Feb-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Zhendong Jin,
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai 200433
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00235

PMID: 35899903



How to cite this URL:
Chen Y, Jin Z. Ethanol ablation is an alternative treatment modality for disconnected pancreatic duct syndrome (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Oct 2]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=351309

This is a case of disconnected pancreatic duct syndrome (DPDS) resulted from severe acute pancreatitis. Pseudocyst appeared repeatedly in the neck of the pancreas, even after twice successful EUS-guided transmural drainages successively with lumen-apposing metal stent and two double-pigtail plastic stents. The two transmural plastic stents were removed after 6 months of placement, the patient developed abdominal distension and found the pseudocyst reappeared 3 months after the removal [Figure 1].
Figure 1: MRCP suggested the pseudocyst reappeared with proximal main pancreatic duct dilatation

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Ethanol ablation of pseudocyst was then adopted for twice with obvious decrease in the cyst size over time. The interval between the two sessions using the same technique [Video 1 [Additional file 1]] was 2 months. One month after each ablation, a computed tomography scan revealed that the cyst was reduced [Figure 2] and eventually resolved completely [Figure 3]. The patient was discharged on the 3rd day each time after the treatments without abnormal symptoms. EUS evaluation was performed 3 months after the second session to confirm the disappearance of the cyst and the necrosis of the pancreatic neck parenchyma [Figure 4].
Figure 2: Computed tomography confirmed a reduction in the size of the cyst a month after the first treatment

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Figure 3: Computed tomography showed complete cyst resolution a month after the second ablation session

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Figure 4: Necrosis of the main pancreatic duct in the neck of the pancreas and disappearance of cysts were found by ultrasound endoscopy during follow-up

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EUS-guided ethanol ablation is technically easy to perform and has been demonstrated to be a safe, feasible, and efficacious treatment modality in the pancreatic cystic lesion.[1],[2] However, we first report on the treatment of DPDS with ethanol ablation. Since the cyst was connected to the main pancreatic duct (MPD) upstream with high pressure, we believed and confirmed that 10 mL of 99% pure ethanol would not cause damage to the upstream pancreatic tissue. This injection may cause rapid dissolution of the scar tissue at the rupture of MPD and the reconnection of MPD. This case reminds us that ethanol ablation will be an alternative method to consider for the treatment of symptomatic DPDS with recurrent pseudocyst, especially when EUS-guided transmural drainages have failed.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. Zhendong Jin is an Associate Editor of the journal. This article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research group.



 
  References Top

1.
DiMaio CJ, DeWitt JM, Brugge WR. Ablation of pancreatic cystic lesions: The use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas 2011;40:664-8.  Back to cited text no. 1
    
2.
Canakis A, Law R, Baron T. An updated review on ablative treatment of pancreatic cystic lesions. Gastrointest Endosc 2020;91:520-6.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

 
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