RESUMO
BACKGROUND AND AIMS: Endoscopic ultrasound-guided pancreatic duct intervention (EUS-PDI) is one of the most technically challenging procedures. There remains a knowledge gap due to its rarity. The aim is to report the accumulated EUS-PDI experience in a tertiary center. METHODS: Single-tertiary center, retrospective cohort study of prospectively collected data during the study period, from Jan 2013-June 2021. RESULTS: In total, 14 patients (85% male; mean age, 61years, range:37-81) and 25 EUS-PDI procedures for unsuccessful endoscopic retrograde pancreatography (ERP) were included. Principal etiology was chronic pancreatitis with pancreatic duct obstruction (78%). EUS-guided assisted (colorant and/or guidewire, rendezvous) ERP was performed in 14/25(56%); and transmural drainage in 11procedures, including pancreaticogastrosmy in 9/25(36%) and pancreaticoduodenostomy in 2/25(8%). Overall technical and clinical success was 78.5%(11/14). Three (21%) patients required a second procedure with success in all cases. Two failed cases required surgery. Three (21%) adverse events(AEs) were noted (fever, n=1; perforation n=1; pancreatitis n=1). Patients underwent a median of 58months (range 24-108) follow-up procedures for re-stenting. Spontaneous stent migration was detected in 50% of cases. CONCLUSIONS: EUS-PDI is an effective salvage therapy for unsuccessful ERP, although 21% of patients may still experience AEs. In case of EUS-guided rendezvous failure, it can cross over to a transmural drainage.
RESUMO
Video 1Peroral antegrade cholangioscopy-guided conversion of dysfunctional choledochoduodenostomy to transpapillary drainage via trans-LAMS (lumen-apposing metal stent).
