ASGE Endoscopy Live: Pancreatobiliary Cases and Updates (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 complained of mild left upper quadrant pain and early satiety with weight loss. Diagnostic imaging revealed 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 developed worsening abdominal pain and was referred to the emergency room, where further imaging and a multidisciplinary discussion took place. A lumen-opposing metal stent (LAMS) was placed to drain the fluid collection, but attempts to biopsy the cystic structure in the head of the pancreas were unsuccessful due to the thickness of the fluid. The patient's symptoms improved after the procedure, and follow-up imaging showed a decrease in the size of the fluid collection. Dr. Gromski performed an ERCP, but had difficulty cannulating the pancreatic duct. Pancreatogram images showed filling defects and papillary projections consistent with intraductal papillary mucinous neoplasm (IPMN). The team performed sphincterotomy and took biopsies of the papillary fronds. A double pigtail stent was placed, and the LAMS was removed. A follow-up ERCP is planned to explore the duct further. The patient will require surgery, and the team will use the information gathered during the procedures to guide the surgical approach.

Asset Subtitle

Evan Fogel, MD

Keywords

alcoholic pancreatitis

fluid-filled collection

cystic structure

ERCP

intraductal papillary mucinous neoplasm

sphincterotomy

surgical approach