A neoplasia intraductal mucinosa papilar (NIMP) pancre\u00e1tica \u00e9 uma neoplasia epitelial, que se caracteriza por prolifera\u00e7\u00e3o papilar e dilata\u00e7\u00e3o do ducto pancre\u00e1tico principal, com consequente forma\u00e7\u00e3o de cisto[i]. As NIMPs s\u00e3o classificadas como tipo ducto pancre\u00e1tico principal (DP), tipo ducto pancre\u00e1tico secund\u00e1rio (DS), ou misto com base no envolvimento topogr\u00e1fico ductal do tumor. Sua identifica\u00e7\u00e3o usualmente \u00e9 feita por colangiopancreatoresson\u00e2ncia magn\u00e9tica (ColangioRM), podendo ser confirmada pelo ultrassom endosc\u00f3pico (USE) com ou sem pun\u00e7\u00e3o ecoguiada, cujo principal achado \u00e9 a confirma\u00e7\u00e3o de comunica\u00e7\u00e3o ductal, corroborado pela presen\u00e7a de c\u00e9lulas mucinosas. Seu tratamento baseia-se nos fatores de risco (sintomas cl\u00ednicos, achados de imagem) pelo fato da NIMP progredir para carcinoma de forma infrequente e muitos pacientes serem assintom\u00e1ticos. Atualmente, as recomenda\u00e7\u00f5es de sociedade sugerem acompanhamento de 2 a 3 anos para cistos < 1 cm; anual de cistos (1 e 2 cm) por um per\u00edodo total de 2 anos e de 3-6 meses para cistos > 2 cm. Qualquer paciente ict\u00e9rico ou com hist\u00f3ria de pancreatite aguda \u00e9 candidato \u00e0 cirurgia com base na localiza\u00e7\u00e3o do cisto e na extens\u00e3o do envolvimento do DP[ii]. A NIMP pode apresentar-se como uma vari\u00e1vel fistulizante, usualmente para o duodeno. Os autores apresentam um caso de forma\u00e7\u00e3o espont\u00e2nea de f\u00edstula gastropancre\u00e1tica secund\u00e1ria a uma NMIP tipo misto detectada e avaliada por endoscopia digestiva alta e ecoendoscopia.<\/p>\n
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CASO CL\u00cdNICO<\/strong><\/h2>\nPaciente do sexo feminino, 68 anos, procurou o servi\u00e7o de gastroenterologia do CHC-UFPR em maio 2018 com queixa de plenitude p\u00f3s-prandial e desconforto abdominal. Solicitados exames diagn\u00f3sticos de rotina, em que um US mostrou les\u00e3o solido-c\u00edstica pancre\u00e1tica a esclarecer. Um exame de ColangioRM mostrou dilata\u00e7\u00e3o e irregularidade ductal a esclarecer, tendo como hip\u00f3teses diagn\u00f3sticas NMIP do tipo misto ou pancreatite cr\u00f4nica calcificante (FIGURA 1). Foi submetida a ecoendoscopia e endoscopia digestiva alta o qual evidenciou NIMP com fistuliza\u00e7\u00e3o para o est\u00f4mago e acentuada dilata\u00e7\u00e3o ductal pancre\u00e1tica com vegeta\u00e7\u00f5es em seu interior (FIGURAS 2, 3 e 4). Foi poss\u00edvel adentrarmos no trajeto fistuloso para obte\u00e7\u00e3o de bi\u00f3psias das vegeta\u00e7\u00f5es.<\/p>\n
A bi\u00f3psia endosc\u00f3pica confirmou NIMP do tipo misto padr\u00e3o intestinal (FIGURA 5) e, conforme os crit\u00e9rios de Fukuoka 2016 (sintomas, acentuada dilata\u00e7\u00e3o ductal) acometimento de toda a gl\u00e2ndula pancre\u00e1tica e o elevado risco de malignidade, foi decidido por pancreatectomia total como op\u00e7\u00e3o para tratamento curativo. Durante o ato cir\u00fargico, n\u00e3o foi poss\u00edvel a dissec\u00e7\u00e3o da cabe\u00e7a pancre\u00e1tica devido a ader\u00eancias em grandes vasos. Foi optado ent\u00e3o por pancreatectomia corpo-caudal, cuja congela\u00e7\u00e3o de margem evidenciou les\u00e3o papilar ductal sem displasia. O procedimento foi associado a gastrectomia parcial e esplenectomia. A paciente apresentou evolu\u00e7\u00e3o p\u00f3s-operat\u00f3ria favor\u00e1vel, recebendo alta 10 dias p\u00f3s-procedimento. O anatomopatol\u00f3gico evidenciou neoplasia mucinosa intraductal papil\u00edfera com displasia de alto grau, sem foco de neoplasia invasora, com acometimento ductal extenso e margem proximal positiva para presen\u00e7a de epit\u00e9lio papilar sem displasia. Seis meses ap\u00f3s o procedimento, a paciente retorna ao hospital por diarreia e desnutri\u00e7\u00e3o, a qual foi manejada com orienta\u00e7\u00f5es diet\u00e9ticas e revis\u00e3o da reposi\u00e7\u00e3o de enzimas pancre\u00e1ticas. Um m\u00eas ap\u00f3s, a paciente \u00e9 reinternada com quadro de sepse sem origem determinada, evoluindo a \u00f3bito em 3 dias a despeito de medidas suportivas e uso de antibi\u00f3tico de largo espectro.<\/p>\n
FIGURA 1 \u2013 Colangioresson\u00e2ncia \u2013 acentuada dilata\u00e7\u00e3o e tortuosidade do ducto pancre\u00e1tico principal (flechas verdes) com sinais de comunica\u00e7\u00e3o fistulosa com o est\u00f4mago ao n\u00edvel do corpo pancre\u00e1tico (flecha azul).<\/p>\n
![\"F\u00edstula](\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/figura-1-Colangioressonancia.png\")
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FIGURA 2 \u2013 Achado ecoendosc\u00f3pico \u2013 presen\u00e7a de vegeta\u00e7\u00e3o intraductal doppler-positivo dentro do ducto pancre\u00e1tico principal (este dilatado), confirmando tratar-se de NIMP tipo misto.<\/p>\n
![\"\"](\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/figura-2-ecoendoscopico.jpg\")
<\/p>\n
<\/p>\n
FIGURA 3 \u2013 Achado endosc\u00f3pico \u2013 presen\u00e7a de uma gota de muco junto \u00e0 parede posterior do est\u00f4mago, confirmando tratar-se de uma neoplasia mucinosa.<\/p>\n
![\"F\u00edstula](\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/figura-3-achado-endoscopico.jpg\")
<\/p>\n
<\/p>\n
FIGURA 4 \u2013 Achado endosc\u00f3pico \u2013 ap\u00f3s adentrado no orif\u00edcio fistuloso, nota-se a parede do ducto pancre\u00e1tico principal (ao fundo) e uma vegeta\u00e7\u00e3o (\u00e0 direita).<\/p>\n
![\"F\u00edstula](\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/figura-4-achado-endoscopico.jpg\")
<\/p>\n
<\/p>\n
FIGURA 5 \u2013 Fotomicrografia demonstrando proje\u00e7\u00e3o papilar e epit\u00e9lio tipo intestinal (flechas amarelas). Hematoxilina-eosina 40x.<\/p>\n
![\"F\u00edstula](\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/figura-5-fotomicrografia.png\")
<\/p>\n
<\/p>\n
DISCUSS\u00c3O<\/strong><\/h2>\nA NIMP pode apresentar como complica\u00e7\u00e3o durante seu seguimento a forma\u00e7\u00e3o de f\u00edstula espont\u00e2nea em \u00f3rg\u00e3os adjacentes em at\u00e9 6% dos casos[i], ou mesmo, muito raramente, ruptura em perit\u00f4nio livre[ii]. A presen\u00e7a de uma f\u00edstula \u00e9 usualmente identificada por exames de imagem n\u00e3o invasivos, tais como a TC de abd\u00f4men e a ColangioRM, pois permitem a identifica\u00e7\u00e3o anat\u00f4mica da f\u00edstula. Tais achados podem ser confirmados por ultrassom endosc\u00f3pico.<\/p>\n
As f\u00edstulas podem ser m\u00faltiplas, ocorrendo em qualquer dos tipos de NIMP (DP, DS ou misto) [iii]. O tipo de f\u00edstula pode variar em comportamento como sendo invasor (tipo penetrante) devido \u00e0 infiltra\u00e7\u00e3o por neoplasia avan\u00e7ada ou por compress\u00e3o local e isquemia da parede do tubo digestivo (tipo mec\u00e2nico), este usualmente n\u00e3o associado \u00e0 malignidade e respons\u00e1vel por at\u00e9 cerca de 2\/3 dos casos de NIMP fistulizante (4). Dentre os s\u00edtios descritos, a NIMP pode fistulizar para o duodeno (65%), seguido de col\u00e9doco (11%), est\u00f4mago (19%) e c\u00f3lon (3%)[iv]. Dentre as f\u00edstulas para o est\u00f4mago, identificamos na literatura um total de 5 casos publicados e 2 s\u00e9ries de casos.<\/p>\n
Embora o achado de f\u00edstula sugira agressividade, nos casos em que ocorre compress\u00e3o (tipo mec\u00e2nico), a sua presen\u00e7a n\u00e3o est\u00e1 necessariamente associada \u00e0 neoplasia invasiva. De fato, o tipo histol\u00f3gico usual nas f\u00edstulas \u00e9 o intestinal6, considerado de baixa agressividade dentre os quatro tipos histol\u00f3gicos de NIMP descritos na literatura. No presente caso, a paciente apresentava tipo histol\u00f3gico intestinal com foco de displasia de alto grau, sem sinais de neoplasia invasora. Entretanto, o acometimento ductal desses pacientes tende a ser difuso por toda a extens\u00e3o do p\u00e2ncreas. Isso determina um dilema terap\u00eautico para pacientes com alto risco cir\u00fargico e idosos, uma vez que a cirurgia com potencial de cura seria a pancreatectomia total, um procedimento de elevado risco e morbidade pr\u00e9 e p\u00f3s-operat\u00f3ria. Clinicamente, a presen\u00e7a de f\u00edstula em si n\u00e3o representa uma situa\u00e7\u00e3o de risco para o paciente. A fistuliza\u00e7\u00e3o, em verdade, pode promover descompress\u00e3o ductal pancre\u00e1tica[v] e melhora dos sintomas[vi], restando apenas o componente secretor da doen\u00e7a, que teoricamente poderia espoliar o paciente por perda proteica. No presente estudo, a paciente referia-se \u00e0 dor abdominal cr\u00f4nica, provavelmente decorrente de pancreatite cr\u00f4nica adjacente.<\/p>\n
Em rela\u00e7\u00e3o \u00e0 conduta, no presente caso, optou-se, inicialmente, por pancreatectomia total, mas foi tecnicamente poss\u00edvel somente a realiza\u00e7\u00e3o de pancreatectomia corpo-caudal (ader\u00eancias ao n\u00edvel da cabe\u00e7a pancre\u00e1tica) e gastrectomia parcial com remo\u00e7\u00e3o do componente fistuloso. A despeito de ter sido realizada uma cirurgia que poupou tecido pancre\u00e1tico, a paciente desenvolveu desnutri\u00e7\u00e3o grave em curto espa\u00e7o de tempo de p\u00f3s-operat\u00f3rio.<\/p>\n
A f\u00edstula gastropancre\u00e1tica \u00e9 considerada rara na literatura e suas consequ\u00eancias, a longo prazo; risco de neoplasia e o intervalo de seguimento n\u00e3o est\u00e3o definidos7. No presente caso, o exame endosc\u00f3pico e endossonogr\u00e1fico foram cruciais para o diagn\u00f3stico e, quanto ao tratamento, faz-se necess\u00e1ria uma avalia\u00e7\u00e3o do risco, ponderando-se as ressec\u00e7\u00f5es pancre\u00e1ticas extensas, principalmente em pacientes idosos e de alto risco.<\/p>\n
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AUTORES<\/strong><\/h2>\nEduardo Aimore Bonin1, Raquel Canzi Almada de Souza1, Renata Pereira Mueller1, Sergio Ossamu Ioshii1, Jos\u00e9 Celso Ardengh 2.<\/p>\n
1- Complexo Hospital de Cl\u00ednicas, Universidade Federal do Paran\u00e1, Curitiba, Brasil.
\n2- Hospital 9 de Julho, Setor de Endoscopia, S\u00e3o Paulo, SP, Brasil, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto da Universidade de S\u00e3o Paulo (HCFMRP-USP). Endoscopia, Ribeir\u00e3o Preto, SP, Brasil.<\/p>\n
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Como citar esse artigo:<\/strong><\/h3>\nAimore E., Canzi R., Pereira R., Ossamu S. e Celso J. Casos Cl\u00ednicos: F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica. Endoscopia Terap\u00eautica; 2020. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/fistula-gastropancreatica-secundaria-neoplasia-intraductal-mucinosa-papilar-pancreatica-achados-de-endoscopia-digestiva-alta-e-de-ultrassom-endoscopico\/<\/em><\/p>\nAcesse o Endoscopia Terap\u00eautica<\/a> para tomar contato com mais artigos comentados<\/a>, assuntos gerais<\/a>, casos cl\u00ednicos<\/a>, quizzes<\/a>, classifica\u00e7\u00f5es<\/a> e mais!<\/p>\n <\/p>\n
Refer\u00eancias<\/strong><\/h2>\n[i] Kobayashi G., Fujita N., Noda Y., Ito K., Horaguchi J., Obana T. Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs. J Gastroenterol. 2010;45(October, 10):1080\u20131089.
\n[ii] Mizuta Y, Akazawa Y, Shiozawa K, Ohara H, Ohba K, Ohnita K, Isomoto H, Takeshima F, Omagari K, Tanaka K, Yasutake T, Nakagoe T, Shirono K, Kohno S. Pseudomyxoma peritonei accompanied by intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2005; 5(4-5):470-4.
\n[iii] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[iv] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[v] Patel A,Allen A, Kuwahara J, Tracy Wadsworth T, Loeffler DM,Xie KL. Intraductal papillary mucinous neoplasm complicated by a gastropancreatic fistula Radiol Case Rep. 2019 Mar; 14(3): 320\u2013323.
\n[vi] Gebran Khneizer,a,d Kavya M. Reddy,b Muhammad B. Hammami,c and Samer Alkaadeb Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis. Gastroenterology Res. 2019 Feb; 12(1): 43\u201347.<\/p>\n
<\/p>\n
VEJA TAMB\u00c9M !<\/strong><\/p>\nARTIGO COMENTADO \u2013 Manejo da Neoplasia Intraductal Papilar Mucinosa (IPMNs) de ductos secund\u00e1rios: um grande estudo unic\u00eantrico para avaliar preditores de malignidade e resultados a longo prazo<\/a><\/h2>\n <\/p>\n
Neoplasia Mucinosa Papilar Intraductal (IPMN)<\/a><\/h2>\n <\/p>\n
DIRETRIZ \u2013 ASGE \u2013 Papel da endoscopia no diagn\u00f3stico e tratamento das neoplasias c\u00edsticas do p\u00e2ncreas<\/a><\/h2>\n <\/p>\n","protected":false},"excerpt":{"rendered":"
F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica \u2013 achados de endoscopia…<\/p>\n","protected":false},"author":1513,"featured_media":4106,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[146],"tipo":[155,154],"volume":[147],"class_list":["post-4105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-146","tipo-cpre","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"\n
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<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\nA NIMP pode apresentar como complica\u00e7\u00e3o durante seu seguimento a forma\u00e7\u00e3o de f\u00edstula espont\u00e2nea em \u00f3rg\u00e3os adjacentes em at\u00e9 6% dos casos[i], ou mesmo, muito raramente, ruptura em perit\u00f4nio livre[ii]. A presen\u00e7a de uma f\u00edstula \u00e9 usualmente identificada por exames de imagem n\u00e3o invasivos, tais como a TC de abd\u00f4men e a ColangioRM, pois permitem a identifica\u00e7\u00e3o anat\u00f4mica da f\u00edstula. Tais achados podem ser confirmados por ultrassom endosc\u00f3pico.<\/p>\n
As f\u00edstulas podem ser m\u00faltiplas, ocorrendo em qualquer dos tipos de NIMP (DP, DS ou misto) [iii]. O tipo de f\u00edstula pode variar em comportamento como sendo invasor (tipo penetrante) devido \u00e0 infiltra\u00e7\u00e3o por neoplasia avan\u00e7ada ou por compress\u00e3o local e isquemia da parede do tubo digestivo (tipo mec\u00e2nico), este usualmente n\u00e3o associado \u00e0 malignidade e respons\u00e1vel por at\u00e9 cerca de 2\/3 dos casos de NIMP fistulizante (4). Dentre os s\u00edtios descritos, a NIMP pode fistulizar para o duodeno (65%), seguido de col\u00e9doco (11%), est\u00f4mago (19%) e c\u00f3lon (3%)[iv]. Dentre as f\u00edstulas para o est\u00f4mago, identificamos na literatura um total de 5 casos publicados e 2 s\u00e9ries de casos.<\/p>\n
Embora o achado de f\u00edstula sugira agressividade, nos casos em que ocorre compress\u00e3o (tipo mec\u00e2nico), a sua presen\u00e7a n\u00e3o est\u00e1 necessariamente associada \u00e0 neoplasia invasiva. De fato, o tipo histol\u00f3gico usual nas f\u00edstulas \u00e9 o intestinal6, considerado de baixa agressividade dentre os quatro tipos histol\u00f3gicos de NIMP descritos na literatura. No presente caso, a paciente apresentava tipo histol\u00f3gico intestinal com foco de displasia de alto grau, sem sinais de neoplasia invasora. Entretanto, o acometimento ductal desses pacientes tende a ser difuso por toda a extens\u00e3o do p\u00e2ncreas. Isso determina um dilema terap\u00eautico para pacientes com alto risco cir\u00fargico e idosos, uma vez que a cirurgia com potencial de cura seria a pancreatectomia total, um procedimento de elevado risco e morbidade pr\u00e9 e p\u00f3s-operat\u00f3ria. Clinicamente, a presen\u00e7a de f\u00edstula em si n\u00e3o representa uma situa\u00e7\u00e3o de risco para o paciente. A fistuliza\u00e7\u00e3o, em verdade, pode promover descompress\u00e3o ductal pancre\u00e1tica[v] e melhora dos sintomas[vi], restando apenas o componente secretor da doen\u00e7a, que teoricamente poderia espoliar o paciente por perda proteica. No presente estudo, a paciente referia-se \u00e0 dor abdominal cr\u00f4nica, provavelmente decorrente de pancreatite cr\u00f4nica adjacente.<\/p>\n
Em rela\u00e7\u00e3o \u00e0 conduta, no presente caso, optou-se, inicialmente, por pancreatectomia total, mas foi tecnicamente poss\u00edvel somente a realiza\u00e7\u00e3o de pancreatectomia corpo-caudal (ader\u00eancias ao n\u00edvel da cabe\u00e7a pancre\u00e1tica) e gastrectomia parcial com remo\u00e7\u00e3o do componente fistuloso. A despeito de ter sido realizada uma cirurgia que poupou tecido pancre\u00e1tico, a paciente desenvolveu desnutri\u00e7\u00e3o grave em curto espa\u00e7o de tempo de p\u00f3s-operat\u00f3rio.<\/p>\n
A f\u00edstula gastropancre\u00e1tica \u00e9 considerada rara na literatura e suas consequ\u00eancias, a longo prazo; risco de neoplasia e o intervalo de seguimento n\u00e3o est\u00e3o definidos7. No presente caso, o exame endosc\u00f3pico e endossonogr\u00e1fico foram cruciais para o diagn\u00f3stico e, quanto ao tratamento, faz-se necess\u00e1ria uma avalia\u00e7\u00e3o do risco, ponderando-se as ressec\u00e7\u00f5es pancre\u00e1ticas extensas, principalmente em pacientes idosos e de alto risco.<\/p>\n
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AUTORES<\/strong><\/h2>\nEduardo Aimore Bonin1, Raquel Canzi Almada de Souza1, Renata Pereira Mueller1, Sergio Ossamu Ioshii1, Jos\u00e9 Celso Ardengh 2.<\/p>\n
1- Complexo Hospital de Cl\u00ednicas, Universidade Federal do Paran\u00e1, Curitiba, Brasil.
\n2- Hospital 9 de Julho, Setor de Endoscopia, S\u00e3o Paulo, SP, Brasil, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto da Universidade de S\u00e3o Paulo (HCFMRP-USP). Endoscopia, Ribeir\u00e3o Preto, SP, Brasil.<\/p>\n
<\/p>\n
Como citar esse artigo:<\/strong><\/h3>\nAimore E., Canzi R., Pereira R., Ossamu S. e Celso J. Casos Cl\u00ednicos: F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica. Endoscopia Terap\u00eautica; 2020. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/fistula-gastropancreatica-secundaria-neoplasia-intraductal-mucinosa-papilar-pancreatica-achados-de-endoscopia-digestiva-alta-e-de-ultrassom-endoscopico\/<\/em><\/p>\nAcesse o Endoscopia Terap\u00eautica<\/a> para tomar contato com mais artigos comentados<\/a>, assuntos gerais<\/a>, casos cl\u00ednicos<\/a>, quizzes<\/a>, classifica\u00e7\u00f5es<\/a> e mais!<\/p>\n <\/p>\n
Refer\u00eancias<\/strong><\/h2>\n[i] Kobayashi G., Fujita N., Noda Y., Ito K., Horaguchi J., Obana T. Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs. J Gastroenterol. 2010;45(October, 10):1080\u20131089.
\n[ii] Mizuta Y, Akazawa Y, Shiozawa K, Ohara H, Ohba K, Ohnita K, Isomoto H, Takeshima F, Omagari K, Tanaka K, Yasutake T, Nakagoe T, Shirono K, Kohno S. Pseudomyxoma peritonei accompanied by intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2005; 5(4-5):470-4.
\n[iii] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[iv] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[v] Patel A,Allen A, Kuwahara J, Tracy Wadsworth T, Loeffler DM,Xie KL. Intraductal papillary mucinous neoplasm complicated by a gastropancreatic fistula Radiol Case Rep. 2019 Mar; 14(3): 320\u2013323.
\n[vi] Gebran Khneizer,a,d Kavya M. Reddy,b Muhammad B. Hammami,c and Samer Alkaadeb Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis. Gastroenterology Res. 2019 Feb; 12(1): 43\u201347.<\/p>\n
<\/p>\n
VEJA TAMB\u00c9M !<\/strong><\/p>\nARTIGO COMENTADO \u2013 Manejo da Neoplasia Intraductal Papilar Mucinosa (IPMNs) de ductos secund\u00e1rios: um grande estudo unic\u00eantrico para avaliar preditores de malignidade e resultados a longo prazo<\/a><\/h2>\n <\/p>\n
Neoplasia Mucinosa Papilar Intraductal (IPMN)<\/a><\/h2>\n <\/p>\n
DIRETRIZ \u2013 ASGE \u2013 Papel da endoscopia no diagn\u00f3stico e tratamento das neoplasias c\u00edsticas do p\u00e2ncreas<\/a><\/h2>\n <\/p>\n","protected":false},"excerpt":{"rendered":"
F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica \u2013 achados de endoscopia…<\/p>\n","protected":false},"author":1513,"featured_media":4106,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[146],"tipo":[155,154],"volume":[147],"class_list":["post-4105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-146","tipo-cpre","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"\n
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\n2- Hospital 9 de Julho, Setor de Endoscopia, S\u00e3o Paulo, SP, Brasil, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto da Universidade de S\u00e3o Paulo (HCFMRP-USP). Endoscopia, Ribeir\u00e3o Preto, SP, Brasil.<\/p>\n
Aimore E., Canzi R., Pereira R., Ossamu S. e Celso J. Casos Cl\u00ednicos: F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica. Endoscopia Terap\u00eautica; 2020. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/fistula-gastropancreatica-secundaria-neoplasia-intraductal-mucinosa-papilar-pancreatica-achados-de-endoscopia-digestiva-alta-e-de-ultrassom-endoscopico\/<\/em><\/p>\n Acesse o Endoscopia Terap\u00eautica<\/a> para tomar contato com mais artigos comentados<\/a>, assuntos gerais<\/a>, casos cl\u00ednicos<\/a>, quizzes<\/a>, classifica\u00e7\u00f5es<\/a> e mais!<\/p>\n <\/p>\n [i] Kobayashi G., Fujita N., Noda Y., Ito K., Horaguchi J., Obana T. Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs. J Gastroenterol. 2010;45(October, 10):1080\u20131089. <\/p>\n VEJA TAMB\u00c9M !<\/strong><\/p>\n <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" F\u00edstula gastropancre\u00e1tica secund\u00e1ria a neoplasia intraductal mucinosa papilar pancre\u00e1tica \u2013 achados de endoscopia…<\/p>\n","protected":false},"author":1513,"featured_media":4106,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[146],"tipo":[155,154],"volume":[147],"class_list":["post-4105","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-146","tipo-cpre","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"\nRefer\u00eancias<\/strong><\/h2>\n
\n[ii] Mizuta Y, Akazawa Y, Shiozawa K, Ohara H, Ohba K, Ohnita K, Isomoto H, Takeshima F, Omagari K, Tanaka K, Yasutake T, Nakagoe T, Shirono K, Kohno S. Pseudomyxoma peritonei accompanied by intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2005; 5(4-5):470-4.
\n[iii] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[iv] Ravaud S., Laurent V., Jausset F., Cannard L., Mandry D., Oliver A. CT and MR imaging features of fistulas from intraductal papillary mucinous neoplasm of the pancreas to adjacent organs: a retrospective study of 423 patients. Eur J Radiol. 2015;84(November, 11):2080\u20132088.
\n[v] Patel A,Allen A, Kuwahara J, Tracy Wadsworth T, Loeffler DM,Xie KL. Intraductal papillary mucinous neoplasm complicated by a gastropancreatic fistula Radiol Case Rep. 2019 Mar; 14(3): 320\u2013323.
\n[vi] Gebran Khneizer,a,d Kavya M. Reddy,b Muhammad B. Hammami,c and Samer Alkaadeb Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis. Gastroenterology Res. 2019 Feb; 12(1): 43\u201347.<\/p>\nARTIGO COMENTADO \u2013 Manejo da Neoplasia Intraductal Papilar Mucinosa (IPMNs) de ductos secund\u00e1rios: um grande estudo unic\u00eantrico para avaliar preditores de malignidade e resultados a longo prazo<\/a><\/h2>\n
Neoplasia Mucinosa Papilar Intraductal (IPMN)<\/a><\/h2>\n
DIRETRIZ \u2013 ASGE \u2013 Papel da endoscopia no diagn\u00f3stico e tratamento das neoplasias c\u00edsticas do p\u00e2ncreas<\/a><\/h2>\n