Clin Endosc.  2017 Mar;50(2):112-116. 10.5946/ce.2017.046.

Endoscopic Ultrasound-Guided Pancreatic Duct Intervention

• Shimamura
• Mosko J
• Teshima C
• May GR

• KMID: 2383527
• DOI: http://doi.org/10.5946/ce.2017.046

Abstract

Endoscopic ultrasound-guided pancreatic duct intervention (EUS-PDI) is an emerging endoscopic approach allowing access and intervention to the pancreatic duct (PD) for patients with failed endoscopic retrograde pancreatography (ERP) or patients with surgically altered anatomy. As opposed to biliary drainage for which percutaneous drainage is an alternative following failed endoscopic retrograde cholangiopancreatography (ERCP), the treatment options after failed ERP are very limited. Therefore, endoscopic ultrasound (EUS)-guided access to the PD and options for subsequent drainage may play an important role as an alternative to surgical intervention. However, this approach is technically demanding with a high risk of complications, and should only be performed by highly experienced endoscopists. In this review, we describe an overview of the current endoscopic approaches, basic technical tips, and outcomes using these procedures.

Keyword

Drainage; Endoscopic ultrasound; Pancreas; Pancreatic duct intervention

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Drainage
Humans
Pancreas
Pancreatic Ducts*
Ultrasonography

Reference

1. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European society of gastrointestinal endoscopy (ESGE) clinical guideline. Endoscopy. 2012; 44:784–800.

2. Chahal P, Baron TH, Topazian MD, Petersen BT, Levy MJ, Gostout CJ. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy. 2006; 38:1241–1245.

3. Devière J. EUS-guided pancreatic duct drainage: a rare indication in need of prospective evidence. Gastrointest Endosc. 2017; 85:178–180.

4. Giovannini M. EUS-guided pancreatic duct drainage: ready for prime time? Gastrointest Endosc. 2013; 78:865–867.

5. François E, Kahaleh M, Giovannini M, Matos C, Devière J. EUS-guided pancreaticogastrostomy. Gastrointest Endosc. 2002; 56:128–133.

6. Kahaleh M, Yoshida C, Yeaton P. EUS antegrade pancreatography with gastropancreatic duct stent placement: review of two cases. Gastrointest Endosc. 2003; 58:919–923.

7. Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc. 2004; 59:100–107.

8. Kinney TP, Li R, Gupta K, et al. Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access. Endoscopy. 2009; 41:898–901.

9. Tessier G, Bories E, Arvanitakis M, et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc. 2007; 65:233–241.

10. Will U, Fueldner F, Thieme AK, et al. Transgastric pancreatography and EUS-guided drainage of the pancreatic duct. J Hepatobiliary Pancreat Surg. 2007; 14:377–382.

11. Brauer BC, Chen YK, Fukami N, Shah RJ. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc. 2009; 70:471–479.

12. Barkay O, Sherman S, McHenry L, et al. Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. Gastrointest Endosc. 2010; 71:1166–1173.

13. Ergun M, Aouattah T, Gillain C, Gigot JF, Hubert C, Deprez PH. Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy. 2011; 43:518–525.

14. Shah JN, Marson F, Weilert F, et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc. 2012; 75:56–64.

15. Fujii LL, Topazian MD, Abu Dayyeh BK, et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc. 2013; 78:854–864.e1.

16. Kurihara T, Itoi T, Sofuni A, Itokawa F, Moriyasu F. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc. 2013; 25 Suppl 2:109–116.

17. Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc. 2012; 76:1133–1141.

18. Ryou M, Mullady DK, Dimaio CJ, Swanson RS, Carr-Locke DL, Thompson CC. Pancreatic antegrade needle-knife (PANK) for treatment of symptomatic pancreatic duct obstruction in Whipple patients (with video). Gastrointest Endosc. 2010; 72:1081–1088.

19. Itoi T, Kasuya K, Sofuni A, et al. Endoscopic ultrasonography-guided pancreatic duct access: techniques and literature review of pancreatography, transmural drainage and rendezvous techniques. Dig Endosc. 2013; 25:241–252.

20. Bataille L, Deprez P. A new application for therapeutic EUS: main pancreatic duct drainage with a “pancreatic rendezvous technique”. Gastrointest Endosc. 2002; 55:740–743.

21. Will U, Meyer F, Manger T, Wanzar I. Endoscopic ultrasound-assisted rendezvous maneuver to achieve pancreatic duct drainage in obstructive chronic pancreatitis. Endoscopy. 2005; 37:171–173.

22. Papachristou GI, Gleeson FC, Petersen BT, Levy MJ. Pancreatic endoscopic ultrasound-assisted rendezvous procedure to facilitate drainage of nondilated pancreatic ducts. Endoscopy. 2007; 39 Suppl 1:E324–E325.

23. Keenan J, Mallery S, Freeman ML. EUS rendezvous for pancreatic stent placement during endoscopic snare ampullectomy. Gastrointest Endosc. 2007; 66:850–853.

24. Cooper ST, Malick J, McGrath K, Slivka A, Sanders MK. EUS-guided rendezvous for the treatment of pancreaticopleural fistula in a patient with chronic pancreatitis and pancreas pseudodivisum. Gastrointest Endosc. 2010; 71:652–654.

25. Itoi T, Kikuyama M, Ishii K, Matsumura K, Sofuni A, Itokawa F. EUS-guided rendezvous with single-balloon enteroscopy for treatment of stenotic pancreaticojejunal anastomosis in post-Whipple patients (with video). Gastrointest Endosc. 2011; 73:398–401.

26. Kawakubo K, Isayama H, Sasahira N, et al. Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes. Surg Endosc. 2013; 27:3437–3443.

27. Fujii-Lau LL, Levy MJ. Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Pancreat Sci. 2015; 22:51–57.

28. Dhir V, Isayama H, Itoi T, et al. EUS-guided biliary and pancreatic duct interventions. Dig Endosc. 2017; Jan. 24. [Epub]. https://doi.org/10.1111/den.12818.

29. Chapman CG, Waxman I, Siddiqui UD. Endoscopic ultrasound (EUS)-guided pancreatic duct drainage: the basics of when and how to perform EUS-guided pancreatic duct interventions. Clin Endosc. 2016; 49:161–167.

30. Itoi T, Sofuni A, Tsuchiya T, et al. Initial evaluation of a new plastic pancreatic duct stent for endoscopic ultrasonography-guided placement. Endoscopy. 2015; 47:462–465.

31. Oh D, Park do H, Cho MK, et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc. 2016; 83:366–373.e2.

32. Elmunzer BJ, Piraka CR. EUS-guided methylene blue injection to facilitate pancreatic duct access after unsuccessful ERCP. Gastroenterology. 2016; 151:809–810.

33. Tyberg A, Sharaiha RZ, Kedia P, et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc. 2017; 85:164–169.

34. Chen YI, Levy MJ, Moreels TG, et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc. 2017; 85:170–177.