ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual)

Video Transcription

Video Summary

In this video, doctors Evan Fogel and Mark Gromski present a case of a 58-year-old man with a history of alcoholic pancreatitis. The patient had complained of left upper quadrant pain and weight loss. Imaging showed a fluid-filled collection, dilated pancreatic duct, and cystic structure in the head of the pancreas. The patient's condition worsened and he was admitted for further workup. His white count was elevated and lipase levels were high. A CT scan showed that the pancreatic duct was obstructed by the cystic structure, and a luminal-opposing metal stent was placed to drain the fluid collection. Pancreatoscopy revealed papillary fronds, indicative of intraductal papillary mucinous neoplasm (IPMN). Spy bites were taken for biopsy. The pancreatic sphincterotomy was performed, and a double pigtail stent was placed in the cystic cavity transpapillary. The luminal-opposing metal stent was removed, and a final double pigtail stent was placed transpapillary to facilitate drainage of the head area. The patient will undergo surgery, and the stents will be removed beforehand. The doctors discussed the risks of leaving a luminal-opposing metal stent in for too long, and the importance of specimen marking during stent deployment. This case provided insights into the diagnosis and management of IPMN and highlighted endoscopic techniques used in the treatment process.

Asset Subtitle

Evan Fogel, MD

Keywords

alcoholic pancreatitis

pancreatic duct

cystic structure

IPMN

endoscopic techniques

stent deployment

diagnosis