Clin Endosc.  2016 Mar;49(2):161-167. 10.5946/ce.2016.011.

Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions

• Chapman CG
• Waxman I
• Siddiqui U

• KMID: 2165040
• DOI: http://doi.org/10.5946/ce.2016.011

Abstract

Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD.

Keyword

Endosonography; Stents; Pancreatic ducts; Drainage; Pancreatic duct intervention

MeSH Terms

Constriction, Pathologic
Drainage*
Endoscopy
Endosonography
Humans
Pancreatic Ducts*
Pancreatitis, Chronic
Patient Selection
Stents
Ultrasonography*

Figure

• 

  Fig. 1. Endoscopic ultrasound (EUS)-guided anterograde pancreatic duct drainage and stenting in a patient with Whipple surgery and anastomotic stenosis. (A) EUS imaging revealing a dilated main pancreatic duct to 10 mm in maximum diameter. (B) The curvilinear echoendoscope is positioned to puncture the main pancreatic duct. (C) A 19 gauge EUS-fine needle aspiration is advanced into the main pancreatic duct and a pancreatogram is obtained revealing a dilated pancreatic duct. (D) A 0.035-inch guidewire is advanced into the main pancreatic duct; however, it is unable to bypass the anastomosis and is coiled in the distal pancreatic duct. (E) The pancreatogastrostomy tract is dilated with a 4 mm × 4 cm dilation balloon. (F) A 7 Fr by 4 cm double pigtail plastic stent was then placed over the wire across the pancreatogastrostomy. The stent position is confirmed endosonographically (G) and endoscopically (H).

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