Clin Endosc.  2020 Jul;53(4):429-435. 10.5946/ce.2019.130.

Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention

• Ogura T
• Ohama H
• Higuchi K

• KMID: 2504946
• DOI: http://doi.org/10.5946/ce.2019.130

Abstract

Endoscopic ultrasound (EUS)-guided pancreatic access is an emergent method that can be divided into the two main techniques of EUS-guided rendezvous and pancreatic transmural stenting (PTS). While many reports have described EUS-guided procedures, the indications, technical tips, clinical effects, and safety of EUS-guided pancreatic duct drainage (EUS-PD) remain controversial. This review describes the current status of and problems associated with EUS-PD, particularly PTS. We reviewed clinical data derived from a total of 334 patients. Rates of technical and clinical success ranged from 63% to 100% and 76% to 100%, respectively. In contrast, the rate of procedure-related adverse events was high at 26.7% (89/334). The most frequent adverse events comprised abdominal pain (n=38), acute pancreatitis (n=15), bleeding (n=9), and issues associated with pancreatic juice leakage such as perigastric fluid, pancreatic fluid collection, or pancreatic juice leaks (n=8). In conclusion, indications for EUS-PTS are limited, as is the evidence of its viability, due to the scarcity of expert operators. Despite improvements made to various devices, EUS-PTS remains technically challenging. Therefore, a long-term, large-scale, multicenter study is required to establish this technique as a viable alternative drainage method.

Keyword

Endoscopic ultrasound; Endoscopic ultrasound-guided pancreatic duct drainage; Pancreatic duct stricture; Endoscopic retrograde cholangiopancreatography; Pancreas

Figure

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  Fig. 1. Technique of endoscopic ultrasound-guided rendezvous. (A) The main pancreatic duct is punctured using 19 G needle, and the contrast medium is injected. (B) The guidewire is inserted into the intestine across the stricture site. (C) The echoendoscope is withdrawn. (D) A duodenoscope is inserted into the ampulla of Vater. (E) After the guidewire is pulled into a duodenoscope, pancreatic cannulation is performed over the guidewire (E).

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  Fig. 2. Technical tips for endoscopic ultrasound-guided pancreatic transluminal stenting. (A) The main pancreatic duct is punctured from the lower or middle of the stomach. (B) The main pancreatic duct is punctured from the upper site of the stomach. (C) The guidewire is inserted into the main pancreatic duct, and the fistula is dilated using a balloon catheter. (D) Plastic stent deployment from the main pancreatic duct to the stomach is performed.

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  Fig. 3. Endoscopic ultrasound-guided antegrade intervention. (A) A pancreatoscope is inserted into the main pancreatic duct. (B) Antegrade endoscopic hydraulic lithotripsy is attempted. (C) The guidewire is successfully inserted into the intestine across huge pancreatic stones. (D) The guidewire is grasped using a basket catheter. (E) Pancreatic duct cannulation is performed. (F) Plastic stent deployment is performed.

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