66例胆胰疾病内镜诊断治疗分析
摘要
目的:探讨经内镜逆行胰胆管造影(ERCP)和内镜下Oddi括约肌切开(EST)在胆胰疾病诊疗中的应用效果。方法:66例胆胰疾病患者行ERCP 68例次,其中2例行2例次。44例胆道梗阻患者同时行磁共振胆胰管成像(MRCP),分析ERCP的诊疗效果以及与MRCP诊断胆管结石符合率相比较。探讨如何进行ERCP诊断及治疗,提高其成功率及并发症的治疗和预防效果。结果:66例行ERCP诊断胆总管结石31例(41.7%),胆管狭窄18例(27.3%),乳头炎性狭窄11例(16.7%),壶腹癌2例(3.0%),慢性胰腺炎2例(3.0%),乳头旁憩室综合症1例(1.5%),单纯胰管显影1例(1.5%)。ERCP与MRCP诊断胆总管结石差异无统计学意义。出现并发症4例(5.9%),轻型胰腺炎1例,高淀粉酶血症1例,2例EST术后出血,经临床治疗痊愈。结论:ERCP对于胆胰疾病诊断及治疗中具有创伤小、安全有效等特点,在胆胰疾病治疗中具有重要地位。
Objective: To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST) for cholangiopancreatic disease. Methods: 66 patients with cholecystopancreatic disease underwent ERCP, 2 cases of them underwent ERCP twice, the subsequent EST to remove the stones and to amputate papilla of Vater. Meanwhile in order to analyse the diagnostic and therapeutic effects of ERCP, 44 patients with bile ducts obstruction performed magnetic resonance cholangiopancreatography(MRCP) in compare. Discuss: how to reduce the occurrence of complication, to provide managements of prevention and treatment associated with the ERCP-induced complications. Results: The most frequent cause was cholelithiasis (41.7%),of them stricture of bile duct (27.3%) was the second frequent cause, constrictive papillitis was 3.09%, cancer of ampullae was 3.0%,chronic pancreatitis was 3.0%, periampullary diverticular was 1.5%, endoscopic retrograde pancreatography was 1.5%. These cases underwent ERCP to make the diagnosis of cholecystopancreatic disease and the subsequent EST to remove the stones,to open papilla of Vater. Only 4 patients of them has got the complications including mild pancreatitis in 1 patient, hyperamylasemia in 1 patient ,gastrointestinal bleeding in 2 patient .Patients with these complications were all cured. Conclusion: The advantage of ERCP is micro-invasive, safe and efficient. ERCP has significant value in diagnosing and treating in cholecystopancreatic disease.
Objective: To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST) for cholangiopancreatic disease. Methods: 66 patients with cholecystopancreatic disease underwent ERCP, 2 cases of them underwent ERCP twice, the subsequent EST to remove the stones and to amputate papilla of Vater. Meanwhile in order to analyse the diagnostic and therapeutic effects of ERCP, 44 patients with bile ducts obstruction performed magnetic resonance cholangiopancreatography(MRCP) in compare. Discuss: how to reduce the occurrence of complication, to provide managements of prevention and treatment associated with the ERCP-induced complications. Results: The most frequent cause was cholelithiasis (41.7%),of them stricture of bile duct (27.3%) was the second frequent cause, constrictive papillitis was 3.09%, cancer of ampullae was 3.0%,chronic pancreatitis was 3.0%, periampullary diverticular was 1.5%, endoscopic retrograde pancreatography was 1.5%. These cases underwent ERCP to make the diagnosis of cholecystopancreatic disease and the subsequent EST to remove the stones,to open papilla of Vater. Only 4 patients of them has got the complications including mild pancreatitis in 1 patient, hyperamylasemia in 1 patient ,gastrointestinal bleeding in 2 patient .Patients with these complications were all cured. Conclusion: The advantage of ERCP is micro-invasive, safe and efficient. ERCP has significant value in diagnosing and treating in cholecystopancreatic disease.
引文
铩颷1]Rosch T.Staging of pancreatic cancer.analysis of literature results.Endlsc Ultrasonsgr,pt Ⅱ,2002;735-753.
[2]Sherman S,Ruffolo TA,Hawes RH,et al.Complications of endoscopicsph-incterotomy:a prospective series with emphasis on increased riskassociated withsphincter of Oddi dysfunction and nondilatated bileducts.Gastroenterology,2003,101(5):1068-1075.
[3]Wallner BK,Sehumacher KA,Weidenmaier W,et al.Dilated biliary tract:evaluationwith MR.cholangiography with a T2 -weighted contrast - enhanced fast sequence.Radiology,2003,181:805-808.
[4]Farrell RJ,Noonan N,Mahmud N,et al.Potential impact of magnetic resonancecholangiopancreatography on endoscopic retrograde cholangiopancreatographyworkload and complication rate in patients referred because of abdominal pain.Endoscopy,2004,33:668-675.
[5]Hdzknecht N,GaugerJ,Sackmann M,et al.Breath - hold MR cholangiography withsnapshot techniques:prospective comparison with endoscopic retrogradecholangiograpgy.Radiology,1998,206:657-664.
[6]施建平,胡运彪,戈之铮,等.磁共振胰胆管造影术与内镜逆行胰胆管造影术的对照研究.中华消化内镜杂志,2000,17(5):268-270.
[7]吴晓鸣,曾飞雁,王昌新,等.MRCP与ERCP对胆道梗阻诊断价值的比较[J].肝胆胰外科杂志,2001,13(4):189-191.
[8]孙凯,孙权,刘志苏.ERCP对壶腹周围癌的早期诊断价值[J].临床外科杂志,2003,11(5):297-298.
[9]Reinhold C,Bret PM.Current status of MR Holan~o pancreat ography[J].AJR,2002,166:1285-1295.
[10]智发朝,颜志强,李晓林,等.磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究.中华消化杂志,2001,21(10):605-607.
[11]Fleck A,Zanotelli ML,Meine M,et al.Biliary tract complications after or thotopic livertransplantation in adult patients[J].Transplant Proc,2002,34(2):519-520.
[12]Johnston TD,Gates R,Reddy KS,et al.Nonoperative management of bileleaksfollowing liver transplantation.Clin Transplant,2004,14(4 Pt 2):365-369.
[13]李兆申,李启勇.ERCP在肝移植后胆道并发症诊治中的应用[J].中华肝胆外科杂志,2004,10(11):787-789.
铩颷14]蒋存兵,王金波.内镜逆行胆胰管造影术诊治肝移植后梗阻性黄疸[J].现代实用医学,2003,17(4):217-217,219.[15]Pfau PR,Kochman ML,Lewis JD,et al.Endoscopic management of postoperativebiliary complications in orthotopic liver transplantation.Gastrointest Endosc,2003,52:55-63.
[16]张筱凤,张啸,李国熊,李平,等.89例多次ERCP的原因探讨.中国内镜杂志,2005,11(2):2015-205.
[17]Pereira-Lima JC,Jakobs R,Winter UH,et al.Long-term results(7to 10 years)ofendoscopic papillotomy for choledocholithiasis:Multivariate analysis of prognosisfactors for the recurrence of biliary symptoms[J].Gastrointest Endosc,2003,48:457-464.
[18]Prat F,Malak NA,Pelletier G,et al.Biliary symptoms and complications more than 8years aider endoscopic sphincterotomy for choledocholithiasis[J].Gastroenterology,2003,110:894-899.
[19]周永碧,李智华,陈敏.内窥镜下十二指肠乳头括约肌切开术治疗胆胰疾病.中华外科杂志,1997,35:274-276。
[20]陆星华.十二指肠乳头旁憩室与胰胆管病变关系探讨.中国内镜杂志,2004,4:23.
[21]Lotric T.Gall-stone disease and juxtapapillary duodenal diverticula.A study of thesphincter function.X th Int Gongr Gastroent,dapest:June 2003.
[22]中国人民解放军第三军医大学《胆道外科》编写组.胆道外科.第4版.北京:人民卫生出版社,2000:137.
[23]Eggert A,TeichmannW,W ittmann DH.The pathologic implication of duodenaldiverticula.Surg Gynecol Obstet,2004,154:62.
[24]Osnes M,Myren J,Lotveit T,et al.Juxtapapillary duodenal divertic ula andabnormalities by endoscopic retrograde cholangiopan crestography(ERCP).Scand JGastroenterol,2003,12:347.
[25]王兴鹏,徐肇敏,许国铭.慢性胰腺炎诊治指南(2005年,南京)中华消化杂志,2005,25(5):319-322.
[26]ASGE Chutkan RK,Ahmad AS,Cohen J,et al.ERCP core curriculum[J].Gastrointest Endosc,2006;63(3):361-376.
[27]Christoforidis E,Goulimaris I,Kanellos I,et al.Post-ERCP pancreatitis andhyperamylasemia:patient-related and operative risk factors[J].Endoscopy,2002,34:286-292.
[28]Sherman S,Lehman GA.ERCP and endocopic sphincterotomy induced pancreatitis. pancreas,2004,6:288-297.
铩颷29]Kim HJ,Kim DI,et al.Endoscopic hemostasis in sphincterotomy inducedhemorrhage:its efficacy and safety.Endoscopy,2004,31:433-436.
[30]Lopertido S,Angelini GP,Benedetti G,et al.Major early complications fromdiagnostic and therapeutic ERCP:a prospective multicenter study[J].GastrointestEndosc,1998,48:1-10.
[31]钱鸣杰,王少峰.小剂量奥曲肽预防ERCP术后高淀粉酶血症及胰腺炎的疗效[J].中国血液流变学.2005,15(1):2 P.267-268.
[32]Freeman M.Prevention of post-ERCP pancreatitis:Pharmacologic solution or patientselection and pancreaticstents[J]Gastroen-terology,2003,124:1977-1980.
[33]Sherrnan S,Ruffolo TA,Hawes RH.Complications of endoscopic sphincterotomy:aprospective series with emphasis on the increased risk associated with sphincter ofOddi dysfunction and norrdilated bile ducts.Castroenterology,2003,101:1068-1075.
[34]Christoforidis E,Coulimaris I,et al.Post-ERCP pancreatitis and hyperanylasemia:patient-related and operative risk factors.Endoscopy,2002,34:286-292.
[35]Testoni PA.Facts and fiction in the pharmacologic prevention of ERCP pancreatitis:a never ending story[J].Gastrointest Endosc 2006,64(5):732-734.
[36]Masci E,Toti G,Mariani A,et al.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study.Am J Gastroenterol,2001,96:417-423.
[37]Freeman ML.Understanding risk factors and avoiding complications with endoscopicretrograde cholangiopancreatography.Curr Gastroenterol Rep,2003,5:145-153.
[38]张啸.内镜下乳头切开术的近期并发症冲华消化内镜杂志,1996,13:290-292.
[39]American society For Gastrointestinal Endoscopy.Guidelines for antibioticprophylaxis for Glendoscopy[J].Gastrointestinal Endoscopy 2003,58(4):475-482.
[40]Cotton PB.Analysis of 59 ERCP lawsuits;mainly about indications[J].GastrointestEndosc,2006,63(3):378-382.
铩颷1]Rosch T.Staging of pancreatic cancer.analysis of literature results.Endlsc Ultrasonsgr,ptⅡ,2004;735-753.
[2]Sherman S,Ruffolo TA,Hawes RH,et al.Complications of endoscopicsph-incterotomy:a prospective series with emphasis on increased riskassociated withsphincter of Oddi dysfunction and nondilatated bileducts.Gastroenterology,2003,101(5):1068-1075.
[3]Komatsu Y,Kawabe J,Toda N,et al.Endoscopic papillary balloondilation for themanagement of common bile duct stones:experience of 226 cases.Endoscopy,1998,30(1):12-17.
[4]Dawson SL,Mueller PR.Interventional radiology in the management of bile ductinjuries.Surg Clin North Am,1994,74:865.
[5]Lozarek RA.Endoscopic techniques in management of biliary tract injuries.SurgClinNorth Am,1994,74:883.
[6]Davids PHP,Tanka AKF,Rauws EAJ,et al.Benign biliary stricture,surgery orendoscopy Ann Surg,1993,217-237.
[7]Bose SM,MazumdarA,Singh V.The role of endoscop ic p roceduresin themanagement of postcholecystectomy and posttraumatic biliaryleak.Surg Today,2004,31(1):45-50.
[8]Costamagna G,PandolfiM,MutignaniM,et al..Long2 term results of endoscop icmanagement of postoperative bile duct strictures withincreasing number of stents.Gastrointest Endosc,2001,54(1):162-168
[9]Costamagna G,Pandolfi M,Mutignani M,et al,.Long2 term results of endoscopicmanagement of postoperative bile duct strictures withincreasing number of stents.Gastrointest Endosc,2004,54(1):162-168.
[10]Pfau PR,Kochman ML,Lewis JD,et al.Endoscopic management of postoperativebiliary complications in orthotopic liver transplantation.Gastrointest Endosc,2000,52:55-63.
[11]Kaw M,Antably Y,Kaw P.Management of gallstone pancreatitis:cholecystectomyor ERCP and endoscopic sphincterotomy.Gastrointest Endosc,2002,56(1):61-65.
[12]Arguedas MR,Dupont AW,Wilcox CM.Where do ERCP,endoscopicultrasoundduring inflammation and host defense.Sci stak 2003,2003:3.
[13]王兴鹏,徐肇敏,许国铭.慢性胰腺炎诊治指南(2005年,南京)中华消化杂志,2005, 25(5):319-322
铩颷14]Riemann JF,Jakobs R.Pancreatic duct stenting in chronic pancreatitis thecontroversies.Z Gastroenterol,2000,38(5):365,366.
[15]Inui K,Yoshino J,Okushima K,et al.EUS2guided one2step drainage of pancreatic pseudocysts:experience in 3 patients.Gastrointest Endosc,2001,54(1):87-89.
[16]Giovannini M,Bemardini D,Seitz JF,et al.Cystogastrotomy entirely performedunder endosonography guidance for pancreatic pseudocyst:results in six patients.Gastrointest Endosc,1998,48(7):200-203.
[17]Huibregtse K,Carr Locke DL,Cremer M,et al.Biliary stent occlusion a problemsolved with setf2expanding metal stents Endoscopy,1992,24(2):391-394.
[18]王辉,李兆申,许国铭,等.良、恶性胰胆管梗阻经内镜内置管引流临床研究.世界华人消化杂志,2000,8(1):15-18.
[19]Schiefke I,Zabel Langhennig A,Wiedmann M.Self2expandable metallic stentsformalignant duodenal obstruction caused by biliary tract cancer.Gastrointest Endosc,2003,58(1):213-219.
[20]李兆申,许国铭,孙振兴,等.胆、胰管良恶性梗阻的双支架联合引流临床研究.中华消化内镜杂志,2001,18(7):475-477.
[2]Sherman S,Ruffolo TA,Hawes RH,et al.Complications of endoscopicsph-incterotomy:a prospective series with emphasis on increased riskassociated withsphincter of Oddi dysfunction and nondilatated bileducts.Gastroenterology,2003,101(5):1068-1075.
[3]Wallner BK,Sehumacher KA,Weidenmaier W,et al.Dilated biliary tract:evaluationwith MR.cholangiography with a T2 -weighted contrast - enhanced fast sequence.Radiology,2003,181:805-808.
[4]Farrell RJ,Noonan N,Mahmud N,et al.Potential impact of magnetic resonancecholangiopancreatography on endoscopic retrograde cholangiopancreatographyworkload and complication rate in patients referred because of abdominal pain.Endoscopy,2004,33:668-675.
[5]Hdzknecht N,GaugerJ,Sackmann M,et al.Breath - hold MR cholangiography withsnapshot techniques:prospective comparison with endoscopic retrogradecholangiograpgy.Radiology,1998,206:657-664.
[6]施建平,胡运彪,戈之铮,等.磁共振胰胆管造影术与内镜逆行胰胆管造影术的对照研究.中华消化内镜杂志,2000,17(5):268-270.
[7]吴晓鸣,曾飞雁,王昌新,等.MRCP与ERCP对胆道梗阻诊断价值的比较[J].肝胆胰外科杂志,2001,13(4):189-191.
[8]孙凯,孙权,刘志苏.ERCP对壶腹周围癌的早期诊断价值[J].临床外科杂志,2003,11(5):297-298.
[9]Reinhold C,Bret PM.Current status of MR Holan~o pancreat ography[J].AJR,2002,166:1285-1295.
[10]智发朝,颜志强,李晓林,等.磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究.中华消化杂志,2001,21(10):605-607.
[11]Fleck A,Zanotelli ML,Meine M,et al.Biliary tract complications after or thotopic livertransplantation in adult patients[J].Transplant Proc,2002,34(2):519-520.
[12]Johnston TD,Gates R,Reddy KS,et al.Nonoperative management of bileleaksfollowing liver transplantation.Clin Transplant,2004,14(4 Pt 2):365-369.
[13]李兆申,李启勇.ERCP在肝移植后胆道并发症诊治中的应用[J].中华肝胆外科杂志,2004,10(11):787-789.
铩颷14]蒋存兵,王金波.内镜逆行胆胰管造影术诊治肝移植后梗阻性黄疸[J].现代实用医学,2003,17(4):217-217,219.[15]Pfau PR,Kochman ML,Lewis JD,et al.Endoscopic management of postoperativebiliary complications in orthotopic liver transplantation.Gastrointest Endosc,2003,52:55-63.
[16]张筱凤,张啸,李国熊,李平,等.89例多次ERCP的原因探讨.中国内镜杂志,2005,11(2):2015-205.
[17]Pereira-Lima JC,Jakobs R,Winter UH,et al.Long-term results(7to 10 years)ofendoscopic papillotomy for choledocholithiasis:Multivariate analysis of prognosisfactors for the recurrence of biliary symptoms[J].Gastrointest Endosc,2003,48:457-464.
[18]Prat F,Malak NA,Pelletier G,et al.Biliary symptoms and complications more than 8years aider endoscopic sphincterotomy for choledocholithiasis[J].Gastroenterology,2003,110:894-899.
[19]周永碧,李智华,陈敏.内窥镜下十二指肠乳头括约肌切开术治疗胆胰疾病.中华外科杂志,1997,35:274-276。
[20]陆星华.十二指肠乳头旁憩室与胰胆管病变关系探讨.中国内镜杂志,2004,4:23.
[21]Lotric T.Gall-stone disease and juxtapapillary duodenal diverticula.A study of thesphincter function.X th Int Gongr Gastroent,dapest:June 2003.
[22]中国人民解放军第三军医大学《胆道外科》编写组.胆道外科.第4版.北京:人民卫生出版社,2000:137.
[23]Eggert A,TeichmannW,W ittmann DH.The pathologic implication of duodenaldiverticula.Surg Gynecol Obstet,2004,154:62.
[24]Osnes M,Myren J,Lotveit T,et al.Juxtapapillary duodenal divertic ula andabnormalities by endoscopic retrograde cholangiopan crestography(ERCP).Scand JGastroenterol,2003,12:347.
[25]王兴鹏,徐肇敏,许国铭.慢性胰腺炎诊治指南(2005年,南京)中华消化杂志,2005,25(5):319-322.
[26]ASGE Chutkan RK,Ahmad AS,Cohen J,et al.ERCP core curriculum[J].Gastrointest Endosc,2006;63(3):361-376.
[27]Christoforidis E,Goulimaris I,Kanellos I,et al.Post-ERCP pancreatitis andhyperamylasemia:patient-related and operative risk factors[J].Endoscopy,2002,34:286-292.
[28]Sherman S,Lehman GA.ERCP and endocopic sphincterotomy induced pancreatitis. pancreas,2004,6:288-297.
铩颷29]Kim HJ,Kim DI,et al.Endoscopic hemostasis in sphincterotomy inducedhemorrhage:its efficacy and safety.Endoscopy,2004,31:433-436.
[30]Lopertido S,Angelini GP,Benedetti G,et al.Major early complications fromdiagnostic and therapeutic ERCP:a prospective multicenter study[J].GastrointestEndosc,1998,48:1-10.
[31]钱鸣杰,王少峰.小剂量奥曲肽预防ERCP术后高淀粉酶血症及胰腺炎的疗效[J].中国血液流变学.2005,15(1):2 P.267-268.
[32]Freeman M.Prevention of post-ERCP pancreatitis:Pharmacologic solution or patientselection and pancreaticstents[J]Gastroen-terology,2003,124:1977-1980.
[33]Sherrnan S,Ruffolo TA,Hawes RH.Complications of endoscopic sphincterotomy:aprospective series with emphasis on the increased risk associated with sphincter ofOddi dysfunction and norrdilated bile ducts.Castroenterology,2003,101:1068-1075.
[34]Christoforidis E,Coulimaris I,et al.Post-ERCP pancreatitis and hyperanylasemia:patient-related and operative risk factors.Endoscopy,2002,34:286-292.
[35]Testoni PA.Facts and fiction in the pharmacologic prevention of ERCP pancreatitis:a never ending story[J].Gastrointest Endosc 2006,64(5):732-734.
[36]Masci E,Toti G,Mariani A,et al.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study.Am J Gastroenterol,2001,96:417-423.
[37]Freeman ML.Understanding risk factors and avoiding complications with endoscopicretrograde cholangiopancreatography.Curr Gastroenterol Rep,2003,5:145-153.
[38]张啸.内镜下乳头切开术的近期并发症冲华消化内镜杂志,1996,13:290-292.
[39]American society For Gastrointestinal Endoscopy.Guidelines for antibioticprophylaxis for Glendoscopy[J].Gastrointestinal Endoscopy 2003,58(4):475-482.
[40]Cotton PB.Analysis of 59 ERCP lawsuits;mainly about indications[J].GastrointestEndosc,2006,63(3):378-382.
铩颷1]Rosch T.Staging of pancreatic cancer.analysis of literature results.Endlsc Ultrasonsgr,ptⅡ,2004;735-753.
[2]Sherman S,Ruffolo TA,Hawes RH,et al.Complications of endoscopicsph-incterotomy:a prospective series with emphasis on increased riskassociated withsphincter of Oddi dysfunction and nondilatated bileducts.Gastroenterology,2003,101(5):1068-1075.
[3]Komatsu Y,Kawabe J,Toda N,et al.Endoscopic papillary balloondilation for themanagement of common bile duct stones:experience of 226 cases.Endoscopy,1998,30(1):12-17.
[4]Dawson SL,Mueller PR.Interventional radiology in the management of bile ductinjuries.Surg Clin North Am,1994,74:865.
[5]Lozarek RA.Endoscopic techniques in management of biliary tract injuries.SurgClinNorth Am,1994,74:883.
[6]Davids PHP,Tanka AKF,Rauws EAJ,et al.Benign biliary stricture,surgery orendoscopy Ann Surg,1993,217-237.
[7]Bose SM,MazumdarA,Singh V.The role of endoscop ic p roceduresin themanagement of postcholecystectomy and posttraumatic biliaryleak.Surg Today,2004,31(1):45-50.
[8]Costamagna G,PandolfiM,MutignaniM,et al..Long2 term results of endoscop icmanagement of postoperative bile duct strictures withincreasing number of stents.Gastrointest Endosc,2001,54(1):162-168
[9]Costamagna G,Pandolfi M,Mutignani M,et al,.Long2 term results of endoscopicmanagement of postoperative bile duct strictures withincreasing number of stents.Gastrointest Endosc,2004,54(1):162-168.
[10]Pfau PR,Kochman ML,Lewis JD,et al.Endoscopic management of postoperativebiliary complications in orthotopic liver transplantation.Gastrointest Endosc,2000,52:55-63.
[11]Kaw M,Antably Y,Kaw P.Management of gallstone pancreatitis:cholecystectomyor ERCP and endoscopic sphincterotomy.Gastrointest Endosc,2002,56(1):61-65.
[12]Arguedas MR,Dupont AW,Wilcox CM.Where do ERCP,endoscopicultrasoundduring inflammation and host defense.Sci stak 2003,2003:3.
[13]王兴鹏,徐肇敏,许国铭.慢性胰腺炎诊治指南(2005年,南京)中华消化杂志,2005, 25(5):319-322
铩颷14]Riemann JF,Jakobs R.Pancreatic duct stenting in chronic pancreatitis thecontroversies.Z Gastroenterol,2000,38(5):365,366.
[15]Inui K,Yoshino J,Okushima K,et al.EUS2guided one2step drainage of pancreatic pseudocysts:experience in 3 patients.Gastrointest Endosc,2001,54(1):87-89.
[16]Giovannini M,Bemardini D,Seitz JF,et al.Cystogastrotomy entirely performedunder endosonography guidance for pancreatic pseudocyst:results in six patients.Gastrointest Endosc,1998,48(7):200-203.
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