Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct

Figure 4 Patient with anastomotic stenosis and painful retention in the pancreatic duct after previous resection of the pancreatic head for a metastasis of bronchial carcinoma. A: After endoscopic ultrasonography-guided puncture and pancreatography, retention of fluid in the pancreatic duct is revealed - there is no flow of contrast through the stenotic anastomosis; B: The guide wire is advanced through the anastomotic stenosis; C: Balloon dilatation of the anastomotic stenosis up to 8 mm; D: Transgastric implantation of a 7-Fr double-pigtail prosthesis as a so-called “ring drainage” (gastropancreatojejunostomy).