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. 2018 Jun 3:2018:8216109.
doi: 10.1155/2018/8216109. eCollection 2018.

Indications for Endoscopic Ultrasound-Guided Pancreatic Drainage: For Benign or Malignant Cases?

Daisuke Uchida  1 , Hironari Kato  1 , Yosuke Saragai  1 , Saimon Takada  1 , Sho Mizukawa  1 , Shinichiro Muro  1 , Yutaka Akimoto  1 , Takeshi Tomoda  1 , Kazuyuki Matsumoto  1 , Shigeru Horiguchi  1 , Hiroyuki Okada  1
Affiliations

Indications for Endoscopic Ultrasound-Guided Pancreatic Drainage: For Benign or Malignant Cases?

Daisuke Uchida et al. Can J Gastroenterol Hepatol. .

Abstract

Background and aims: Recurrent pancreatitis associated with pancreatic strictures requires treatment with endoscopic retrograde pancreatography (ERP), but it is sometimes technically unsuccessful. Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was developed as an alternative to a surgical approach after failed ERP; however, the indications for EUS-PD are unclear. In this study, we evaluated the outcomes of EUS-PD and established the indications for EUS-PD.

Methods: A total of 15 patients had indications for EUS-PD for recurrent pancreatitis due to pancreatic strictures. There were eight patients with benign pancreatic strictures and seven with malignant pancreatic strictures. The success rate, adverse events, and long-term outcomes were evaluated.

Results: The technical success rates of benign and malignant strictures were 75% (6/8) and 100% (7/7), respectively, and clinical success was achieved in 100% (6/6) and 87.5% of cases (6/7), respectively. Rendezvous procedures were performed in two patients with benign strictures. The adverse event (AE) rate was 26.7% (4/15) and included cases of peritonitis, bleeding, and stent migration. Reinterventions were performed in three patients with benign strictures and two with malignant strictures.

Conclusions: EUS-PD was an appropriate treatment for not only benign strictures but also malignant strictures with recurrent pancreatitis after failed ERP. However, the AE rate was high, and reinterventions were required in some cases during long-term follow-up. The indications for EUS-PD should be considered carefully, and careful follow-up is needed.

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Figures

Figure 1
Figure 1
The EUS-PD procedure for a patient with obstructive pancreatitis due to pancreatic head cancer. (a) The pancreatic duct was punctured via the stomach with a 19-gauge needle under EUS guidance. (b) The pancreatogram was obtained by the injection of contrast agent. (c) A 0.025-inch guidewire was advanced into the pancreatic duct, and the tract was dilated using a long-tapered catheter or a diathermy catheter. (d) A 7-Fr plastic stent was inserted over the guidewire.
Figure 2
Figure 2
Bleeding occurred at the 371st day after EUS-PD in case 3. (a) Arterial bleeding from the transgastric puncture tract. (b) Contrast-enhanced computed tomography revealed extravasation into the stomach (arrow). (c) Interventional radiology revealed a pseudoaneurysm from the left gastric artery (arrow), and arterial embolization was performed.
See this image and copyright information in PMC

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