Endoscopic ultrasound‐guided pancreatic duct drainage

Abstract

Endoscopic ultrasound (EUS) has evolved from a purely diagnostic procedure to one with therapeutic capabilities. One of the most challenging therapeutic intervention for endosonographers is EUS-guided pancreatic drainage. The development of this technique has allowed access and drainage of the main pancreatic duct after failed endoscopic retrograde pancreatography and can avoid invasive procedures such as surgical and percutaneous interventions. This review discusses the indications, technique, challenges, and an algorithmic approach to EUS-guided pancreatic drainage.

Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel

“…Outcomes in over 200 patients who received EUS-PD showed a pooled technical success rate of 76.6% and adverse events of 18.9% 118. In patients where the papilla can be reached by the duodenoscope, pancreatic duct drainage should be attempted by ERP first.…”

Advances in endotherapy in chronic pancreatitis

“…52 It is important to note that in the antegrade technique, tract dilation is necessary to be able to pass the visceral wall and connect the lumen to the pancreatic duct. 52,53 Chen et al 54 recently published a video case series where different techniques of pancreatic duct drainage are showcased.…”

“…The same author recently published a review paper summarizing the outcomes of multiple studies, including 222 patients, where the technique was successful in 77% of cases. 53 In general, EUS-PD drainage has adequate technical success rates, although complications are common. These complications include pancreatitis, pancreatic leaks, bleeding, perforation and even fatal events.…”

“…These complications include pancreatitis, pancreatic leaks, bleeding, perforation and even fatal events. 59,60 Adverse outcomes reported by the Fujii-Lau and Levy 53 review found that 18.9% of patients suffered adverse events associated with EUS-PD drainage. EUS-PD drainage can lead to a significant number of stent-related adverse events ranging from 25% to 55% of cases.…”

Endoscopic and Conservative Management of Chronic Pancreatitis and Its Complications

“…Several case reports have described EUS drainage of the MPD in benign conditions [129] and unresectable pancreatic cancer [130] as a salvage access route in patients with strong indication for ductal drainage because of recurrent pancreatitis. Access can be transduodenal or transgastric [131] depending on the position of the ductal obstruction.…”