Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2015; 21(46): 13140-13151
Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13140
Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct
Uwe Will, Andreas Reichel, Frank Fueldner, Frank Meyer
Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany
Frank Meyer, Department of General, Abdominal and Vascular Surgery, University Hospital, 39120 Magdeburg, Germany
Author contributions: Will U, Reichel A and Fueldner F designed and performed the research; Will U, Reichel A, Fueldner F and Meyer F analyzed and evaluated data; Will U and Meyer F wrote the paper; and Meyer F proofread the final version.
Institutional review board statement: The study was performed according to the recommendations of the 1964 Declaration of Helsinki for Biomedical Research and its later amendments, and according to the standards of the GCP and the guidelines of our hospital’s institutional review board.
Informed consent statement: Each patient gave written informed consent prior to the intervention.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: Technical appendix, (descriptive) statistical code and dataset available from the first author, Prof. Dr. U.Will at uwe.will@wkg.srh.de. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Uwe Will, MD, Head, Professor, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), Strasse des Friedens 122, 07548 Gera, Germany. uwe.will@wkg.srh.de
Telephone: +49-365-8282401 Fax: +49-365-8282402
Received: February 3, 2015
Peer-review started: February 6, 2015
First decision: April 13, 2015
Revised: June 17, 2015
Accepted: August 28, 2015
Article in press: August 31, 2015
Published online: December 14, 2015
Processing time: 308 Days and 22.4 Hours
Abstract

AIM: To evaluate the use of translumenal pancreatography with placement of endoscopic ultrasonography (EUS)-guided drainage of the pancreatic duct.

METHODS: This study enrolled all consecutive patients between June 2002 and April 2014 who underwent EUS-guided pancreatography and subsequent placement of a drain and had symptomatic retention of fluid in the pancreatic duct after one or more previous unsuccessful attempts at endoscopic retrograde cannulation of the pancreatic duct. In all, 94 patients underwent 111 interventions with one of three different approaches: (1) EUS-endoscopic retrograde drainage with a rendezvous technique; (2) EUS-guided drainage of the pancreatic duct; and (3) EUS-guided, internal, antegrade drainage of the pancreatic duct.

RESULTS: The mean duration of the interventions was 21 min (range, 15-69 min). Mean patient age was 54 years (range, 28-87 years); the M:F sex ratio was 60:34. The technical success rate was 100%, achieving puncture of the pancreatic duct including pancreatography in 94/94 patients. In patients requiring drainage, initial placement of a drain was successful in 47/83 patients (56.6%). Of these, 26 patients underwent transgastric/transbulbar positioning of a stent for retrograde drainage; plastic prostheses were used in 11 and metal stents in 12. A ring drain (antegrade internal drainage) was placed in three of these 26 patients because of anastomotic stenosis after a previous surgical intervention. The remaining 21 patients with successful drain placement had transpapillary drains using the rendezvous technique; the majority (n = 19) received plastic prostheses, and only two received metal stents (covered self-expanding metal stents). The median follow-up time in the 21 patients with transpapillary drainage was 28 mo (range, 1-79 mo), while that of the 26 patients with successful transgastric/transduodenal drainage was 9.5 mo (range, 1-82 mo). Clinical success, as indicated by reduced or absence of further pain after the EUS-guided intervention was achieved in 68/83 patients (81.9%), including several who improved without drainage, but with manipulation of the access route.

CONCLUSION: EUS-guided drainage of the pancreatic duct is a safe, feasible alternative to endoscopic retrograde drainage when the papilla cannot be reached endoscopically or catheterized.

Keywords: Endoscopic ultrasonography; Endoscopic ultrasonography-guided drainage of the pancreatic duct; Endoscopic ultrasonography-guided transmural pancreatography; Prospective, long-term, single-center study; Plastic prosthesis; Metal stent; Clinical success; Technical success

Core tip: Endoscopic ultrasonography-guided drainage of the pancreatic duct (EUPD) can be considered a safe and feasible procedure and an alternative to surgical intervention for a select group of patients. Currently, EUPD remains an experimental clinical procedure, and it should be performed only in experienced hands with great expertise in interventional endoscopy/endoscopic ultrasonography. Further studies are recommended, perhaps in a multi-center design, to finally assess the clinical value of EUPD and to determine general selection criteria of patients for the procedure, as well as criteria for the technical/clinical success.