Clin Endosc.  2024 Sep;57(5):666-674. 10.5946/ce.2023.272.

Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan

• Sadek A
• Hara K
• Okuno N
• Haba S
• Kuwahara T
• Fukui T
• Urata M
• Kondo T
• Yamamoto Y
• Tachi K

• KMID: 2559218
• DOI: http://doi.org/10.5946/ce.2023.272

Abstract

Background/Aims
Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Keyword

Endoscopic ultrasonography; Drainage; Gastrointestinal endoscopic surgical procedures; Pancreatic ducts; Pancreaticoduodenectomy

Figure

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  Fig. 1. Tornus dilator. (A) Tornus ES (Asahi Intecc.) (0.025-inch guidewire-compatible type). (B) The drill like part with tapering end at 3 cm from the tip.

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  Fig. 2. Endoscopic ultrasound-guided pancreatic duct drainage procedure steps. (A) Main pancreatic duct (MPD) puncture using a 22 G fine-needle aspiration needle. (B) 0.018-inch guidewire insertion in the MPD. (C) Dilation of the tract using a Tornus ES dilator (0.018-inch guidewire-compatible type). (D) Guidewire passed the anastomotic stricture with contrast in the jejunum. (E) Balloon dilation for the anastomotic stricture. (F) A plastic stent (single pigtail) was inserted from the stomach into the jejunum (ring drainage).

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