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

Abstract

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.

Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

“…The detailed study quality evaluation is presented in Supplementary Table 3 . Based on the New-Castle Ottawa scoring system, five studies 7 10 22 24 27 were considered to be of high quality and 17 studies 6 8 9 11 12 13 14 15 16 17 18 19 20 21 23 25 26 were considered to be of medium quality. There were no low-quality studies.…”

“…EUS-PDD can help avoid invasive surgery. Data on the efficacy and safety of EUS-PDD are limited 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 . The aims of this study were to qualitatively and quantitatively appraise the current available data on EUS-PDD by meta-analysis methods.…”

Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting

“…In a retrospective study evaluating 44 EUS-PD cases, one of the following was used as the dilation method for EUS-PD: a Soehendra stent retriever, a Hurricane RX (Boston Scientific), or a Cysto-Gastro Set. 15 The authors noted that a Hurricane RX or Cysto-Gastro Set was used for antegrade transmural tract dilation, while the Soehendra stent retriever or Cysto-Gastro Set was used for retrograde transmural tract dilation after rendezvous, respectively. The technical success in this study was 84.1% (37/44), and the most common cause for failure of the procedure was reported to be an inability to puncture the MPD because of severe fibrosis and calcification in the pancreas.…”

“…Most stents that are reported to be placed transmurally in EUS-PD are plastic stents. [4][5][6]15 Both straight and pig tail stents with diameters of 5 to 7 Fr have been frequently used. When plastic stents are selected for EUS-PTS, an "all-in-one stent" is recommended to avoid insertion failure.…”

“…The rates of technical success and adverse events of EUS-PTS using plastic stents were reported to range from 80.9% to 100% and from 12.5% to 26.7%, respectively. 3,5,6,15,27 These immediate adverse events included abdominal pain, peritonitis, bleeding, pancreatic fluid collection, MPD leakage, and perforation. Matsunami et al evaluated the usefulness of the 7 Fr single pigtail type plastic stent (CX-T stent, TYPE IT; Gadelius Medical Co., Tokyo, Japan; Fig.…”