Download PDF
CC BY 4.0 · Endoscopy 2023; 55(S 01): E1217-E1218
DOI: 10.1055/a-2208-5363
E-Videos

Aspiration of tissues and ascites: the solution to endoscopic ultrasound-related duodenal perforation during pancreatic cancer sampling

Qin Lu‡
1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
,
Zhi-qiang Du‡
2   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, China
,
Xiang-rong Zhou
2   Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, China
,
Min Yang
1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
,
Rui Huang
1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
,
Wei-hui Liu 
1   Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
› Author Affiliations
› Further Information
Also available at
 
 PDF Download Permissions and Reprints

Duodenal perforation is one of the most severe complications of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) [1] [2] [3] [4] [5]. Here we report on a patient with a large duodenal perforation during EUS-FNA who was successfully treated under endoscopy with purse-string suture, release of abdominal gas, aspiration of tissues and ascites, and sufficient decompression and drainage ([Video 1]).


Quality:
Endoscopic ultrasound (EUS)-guided fine-needle aspiration of ascites and tissues in a patient with EUS-related large duodenal perforation.Video 1

An 80-year-old woman was referred to our unit to undergo EUS-FNA for diagnosis of a pancreatic lesion. After a hypoechoic area approximately 2.1×1.7 cm in size was found in the pancreatic head ([Fig. 1] a), a perforation measuring approximately 1.0 cm in diameter was clearly seen at the junction of the descending duodenum ([Fig. 1] b). The procedure was immediately discontinued, and 10 endoclips and a nylon ring were used to create a purse-string suture of the perforation ([Fig. 1] c). Meanwhile, the free intraperitoneal gas was released by a syringe to reduce the abdominal tension. Then, 600 mL of light-yellow liquid was aspirated from the abdominal cavity by a 19 G puncture needle after complete closure of the perforation was confirmed ([Fig. 1] d). Histological tissues were obtained during repeat EUS-FNA and confirmed the lesion to be pancreatic cancer ([Fig. 1] e). Finally, a nasoduodenal tube with multiple lateral foramina was placed for local drainage and decompression. A repeat abdominal computed tomography scan indicated no newly increased gas and fluid in the abdomen ([Fig. 1] f). The patient remained asymptomatic and was discharged 1 week later.

Zoom Image
Fig. 1 Management of endoscopic ultrasound (EUS)-related duodenal perforation during pancreatic cancer sampling. a A pancreatic head lesion was detected on EUS. b A perforation measuring approximately 1.0 cm in diameter was seen at the junction of the descending duodenal bulb. c Endoscopic image after 10 endoclips and a nylon ring were used to create a purse-string suture of the EUS-related large duodenal perforation. d EUS-guided fine-needle aspiration (FNA) was performed to remove large amounts of ascites in the abdominal cavity. e Histological tissues were obtained during EUS-FNA. f After the endoscopic repair, no new increase in free gas and fluid was detected on computed tomography.

In summary, we used a puncture needle to aspirate both ascites and sufficient tissues after complete closure of the perforation, allowing both clarification of the pathological diagnosis and reduction of the risk of complications, such as infection. This method proved to be beneficial not only for diagnosis but also for closure of the perforation, making it a potential preferred endoscopic therapeutic option for duodenal perforation in the future.

Endoscopy_UCTN_Code_CPL_1AL_2AB

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videosis an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.


#

Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Fujita A, Tashima T, Tanisaka Y. et al. Endoscopic closure using an over-the-scope clip for pancreatobiliary endoscopy-related large gastrointestinal perforation (with video). DEN Open 2021; 2: e48
    CrossrefPubMedSearch in Google Scholar
  • 2 Mizuide M, Ryozawa S, Fujita A. et al. Complications of endoscopic ultrasound-guided fine needle aspiration: a narrative review. Diagnostics (Basel) 2020; 10: 964
    CrossrefPubMedSearch in Google Scholar
  • 3 Mangiavillano B, Arena M, Morandi E. et al. Successful closure of an endoscopic ultrasound-induced duodenal perforation using an over-the-scope-clip. Endoscopy 2014; 46: E206-E207
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Lee JH, Kedia P, Stavropoulos SN. et al. AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract: expert review. Clin Gastroenterol Hepatol 2021; 19: 2252-2261.e2252
    CrossrefPubMedSearch in Google Scholar
  • 5 Yokozuka K, Chiba N, Koganezawa I. et al. Clinical features required for pancreatoduodenectomy for noniatrogenic duodenal perforation. Am Surg 2020; 86: 508-510
    CrossrefPubMedSearch in Google Scholar

Correspondence

Wei-hui Liu, MD
Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Western First Ring Road 32
610072 Sichuan
China   

Publication History

Article published online:
05 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Fujita A, Tashima T, Tanisaka Y. et al. Endoscopic closure using an over-the-scope clip for pancreatobiliary endoscopy-related large gastrointestinal perforation (with video). DEN Open 2021; 2: e48
    CrossrefPubMedSearch in Google Scholar
  • 2 Mizuide M, Ryozawa S, Fujita A. et al. Complications of endoscopic ultrasound-guided fine needle aspiration: a narrative review. Diagnostics (Basel) 2020; 10: 964
    CrossrefPubMedSearch in Google Scholar
  • 3 Mangiavillano B, Arena M, Morandi E. et al. Successful closure of an endoscopic ultrasound-induced duodenal perforation using an over-the-scope-clip. Endoscopy 2014; 46: E206-E207
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Lee JH, Kedia P, Stavropoulos SN. et al. AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract: expert review. Clin Gastroenterol Hepatol 2021; 19: 2252-2261.e2252
    CrossrefPubMedSearch in Google Scholar
  • 5 Yokozuka K, Chiba N, Koganezawa I. et al. Clinical features required for pancreatoduodenectomy for noniatrogenic duodenal perforation. Am Surg 2020; 86: 508-510
    CrossrefPubMedSearch in Google Scholar

   Permissions and Reprints
Zoom Image
Fig. 1 Management of endoscopic ultrasound (EUS)-related duodenal perforation during pancreatic cancer sampling. a A pancreatic head lesion was detected on EUS. b A perforation measuring approximately 1.0 cm in diameter was seen at the junction of the descending duodenal bulb. c Endoscopic image after 10 endoclips and a nylon ring were used to create a purse-string suture of the EUS-related large duodenal perforation. d EUS-guided fine-needle aspiration (FNA) was performed to remove large amounts of ascites in the abdominal cavity. e Histological tissues were obtained during EUS-FNA. f After the endoscopic repair, no new increase in free gas and fluid was detected on computed tomography.