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

Video Transcription

Video Summary

In this video, Dr. Evan Fogel and Dr. Mark Gromski present a case of a 58-year-old man with a history of alcoholic pancreatitis. The patient had a fluid-filled collection in the left upper quadrant, a dilated pancreatic duct, and a cystic structure in the head of the pancreas. The patient complained of left upper quadrant pain and weight loss, and was referred to the emergency room. The patient's white count was elevated and lipase levels were high. A CT scan was repeated, and a multidisciplinary discussion was held. An eosin was done, and a lumin-opposing metal stent was placed to drain the fluid collection. A double pigtail plastic stent was also placed. The head of pancreas cyst cytology showed no evidence of dysplasia or cancer. The patient's symptoms improved, and he was discharged. Follow-up imaging showed a decrease in size of the left upper quadrant collection with the lumin-opposing metal stent in place. During an ERCP, the doctors were unable to advance a wire into the pancreatic duct, but they performed a pancreatic sphincterotomy and obtained biopsies of papillary fronds. They placed a single double pigtail stent in the cystic cavity and removed the lumin-opposing metal stent. They also placed another double pigtail stent transpapillary. The patient is being prepared for surgery, and further decisions will be made based on the results of the procedures. This video was presented by Dr. Evan Fogel and Dr. Mark Gromski at Indiana University.

Asset Subtitle

Evan Fogel, MD

Keywords

alcoholic pancreatitis

fluid-filled collection

dilated pancreatic duct

cystic structure

left upper quadrant pain

lumin-opposing metal stent

Indiana University