Endoscopic Ultrasound-Guided Pancreatic Duct Intervention

Shimamura, Yuto; Mosko, Jeffrey D.; Teshima, Christopher; May, Gary R.

doi:10.5946/ce.2017.046

Cited by 17 publications

(6 citation statements)

References 34 publications

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“…EUS-guided PD drainage is technically challenging, has limited indications, and is generally performed at select high volume centers, therefore only small series have been reported. Technical contraindications for EUS-guided PD drainage include the inability to localize the MPD endosonographically, the presence of significant intervening vasculature in the intended puncture path, and there being multiple MPD strictures [104,107,108].…”

Section: Recommendationmentioning

confidence: 99%

“…In some instances, EUS-guided PD drainage may be contraindicated, including inability to localize the MPD endosonographically or when the PD is not sufficiently dilated, as well as the presence of significant intervening vasculature in the intended puncture path, and multiple MPD strictures [104,107,108].…”

Section: What Are the Contraindications For Eus-guided Pd Drainage?mentioning

confidence: 99%

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Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Section: What Are the Contraindications For Eus-guided Pd Drainage?mentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Endoscopic ultrasound (EUS) has evolved over the years from being just a diagnostic procedure to being used for advanced therapeutic interventions . EUS‐guided PD intervention (EUS‐PDI) allows quick access to the PD in patients after an unsuccessful ERP or in those with surgically altered anatomy . It is a demanding procedure for any skilled endosonographer and its major advantage lies in preventing surgery, percutaneous approaches and long‐term complications.…”

Section: Introductionmentioning

confidence: 99%

“…7 EUS-guided PD intervention (EUS-PDI) allows quick access to the PD in patients after an unsuccessful ERP or in those with surgically altered anatomy. 8 It is a demanding procedure for any skilled endosonographer and its major advantage lies in preventing surgery, percutaneous approaches and long-term complications. Proper patient selection and experience of the endosonographer is critical for the success of EUS-PDI.…”

Section: Introductionmentioning

confidence: 99%

Six‐year retrospective analysis of endoscopic ultrasonography‐guided pancreatic ductal interventions at a tertiary referral center

Dalal

Patil

Maydeo

2019

Digestive Endoscopy

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Background and Aim Endoscopic ultrasonography‐guided pancreatic ductal intervention (EUS‐PDI) serves as a rescue therapy in patients with failure of retrograde access to the pancreatic duct (PD) at the time of endoscopic retrograde pancreatography (ERP). We review our experience of this procedure. Methods This is a retrospective study of patients who underwent EUS‐PDI for an unsuccessful ERP and altered anatomy. Results A total of 44 (65.9% male) patients underwent EUS‐PDI with a mean age of 43.5 years, (range: 23–67). Transgastric rendezvous technique was carried out in 23/44 (52.3%), transgastric pancreaticogastrostomy in 18/44 (40.9%) and transduodenal pancreaticobulbostomy in 3/44 (6.8%). Overall technical and clinical success was seen in 88.6% (39/44) and 81.8% (36/44), respectively. Technical success of transgastric rendezvous was 95.6% and that of transgastric pancreaticogastrostomy was 77.8%. Two of seven patients with failure to access the PD had successfully undergone EUS‐PD stenting at subsequent attempt. Ten immediate adverse events (AE) were noted which included abdominal pain (n = 4), pancreatitis (n = 2), fever (n = 2), minor bleeding (n = 1), and stripping of wire (n = 1). Delayed AE included stent blockage in 12/39 (30.8%) and spontaneous stent migration in 5/39 (12.8%) which were managed with stent exchange at follow up. The rendezvous technique was associated with fewer AE than transgastric pancreaticogastrostomy. Conclusions Endoscopic ultrasonography‐PDI is an effective treatment modality and salvage therapy in patients with unsuccessful ERP. Technical and clinical success seen with this study is comparable to studies conducted across the world. EUS‐PDI needs to show cost‐effectiveness in future studies.

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“…Una vez que se logra el acceso exitoso al Wirsung, el drenaje ductal se puede realizar mediante técnicas de rendezvous o la ruta transmural (34). En vista del desafío técnico planteado por los procedimientos de rendezvous guiados por USE y la alta frecuencia de las complicaciones, actualmente se recomienda solo para pacientes seleccionados en centros de atención terciaria con la infraestructura y experiencia adecuadas (35).…”

Section: Use Después De Una Cpre Fallidaunclassified

Intervencionismo endoscópico en la pancreatitis crónica

Llano

Artifon²

2019

Rev Colomb Gastroenterol

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La pancreatitis crónica es un trastorno irreversible y progresivo del páncreas caracterizado por inflamación, fibrosis y cicatrización. Las funciones exocrinas y endocrinas se pierden, lo que a menudo conduce al dolor crónico. La etiología es multifactorial, aunque el alcoholismo es el factor de riesgo más importante en los adultos. Si se sospecha pancreatitis crónica, la tomografía computarizada con contraste es la mejor modalidad de diagnóstico por imágenes. Aunque los narcóticos y los antidepresivos proporcionan el mayor alivio del dolor, más de la mitad de los pacientes eventualmente requiere una intervención por endoscopia o cirugía. La colangiopancreatografía retrógrada endoscópica es una alternativa eficaz para una variedad de terapias en el tratamiento de enfermedades benignas y malignas del páncreas. En los últimos 50 años, la endoterapia ha evolucionado hasta convertirse en la terapia de primera línea en la mayoría de las enfermedades inflamatorias agudas y crónicas del páncreas. A medida que avanza este campo, es importante que los gastroenterólogos mantengan un conocimiento adecuado de la indicación del procedimiento, mantengan el volumen de procedimiento suficiente para manejar la endoterapia pancreática compleja y comprendan enfoques alternativos a las enfermedades pancreáticas, incluidos el tratamiento médico, la terapia guiada por ecografía endoscópica, el manejo de las estenosis sintomáticas y cálculos, las intervenciones sobre el plexo celíaco y el drenaje de los pseudoquistes pancreáticos.

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Endoscopic Ultrasound-Guided Pancreatic Duct Intervention

Cited by 17 publications

References 34 publications

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Six‐year retrospective analysis of endoscopic ultrasonography‐guided pancreatic ductal interventions at a tertiary referral center

Intervencionismo endoscópico en la pancreatitis crónica

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