tailieunhanh - Gastrointestinal Endoscopy - part 8

Nội soi tiêu hóa • nội soi điều trị cho sự biện giải đau trong viêm tụy mãn tính có kết quả khác nhau. Hầu hết các phản ứng thuận lợi thường xảy ra với khai thác cản trở đá ống tụy xa. Kết quả là không chắc chắn khi có hẹp còn lại và / hoặc nhu mô Đau tiên tiến disease. | 178 Gastrointestinal Endoscopy 20 Endoscopic therapy for palliation of pain in chronic pancreatitis has variable results. Most favorable responses generally occur with extraction of obstructing distal pancreatic duct stones. Outcome is less certain when there are residual strictures and or advanced parenchymal Pain relief is variable for stenting and or dilation of dominant strictures in chronic pancreatitis. Strictures may occasionally permanently resolve with endoscopic therapy but long term stenting is often It is unclear whether favorable short-term response to pancreatic stenting predicts a favorable response to surgical decompressive therapies such as a Peustow procedure lateral pancreaticojejunostomy . Endoscopic pseudocyst drainage results in 70 to 100 resolution with recurrence rates of 6-20 depending in part on whether any underlying pancreatic ductal disease was simultaneously treated. In general endoscopic drainage of pseudocysts has similar success complication and relapse rates to surgical drainage. Combinations of therapeutic modalities including endoscopic transpapillary and transluminal drainage or endoscopic and percutaneous radiological drainage or surgical drainage are sometimes In order to reduce risk of iatrogenic pancreatitis pancreatic stenting is increasingly used in advanced endoscopy centers to aid in accessing the bile duct during precut sphincterotomy or in conjunction with biliary sphincterotomy in high-risk patients such as those with sphincter of Oddi dysfunction. There are few published data. Complications Pancreatitis Hemorrhage Pancreatic and biliary sepsis Perforation - retroperitoneal from sphincterotomy - ductal from guidewires Stent related - occlusion - migration into or out of the duct - ulceration obstruction by migrated stent General cardiopulmonary and other complications related to ERCP sedation and analgesia Pancreatitis is the most common complication of ERCP and is usually defined by