Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2022; 14(8): 487-494
Published online Aug 16, 2022. doi: 10.4253/wjge.v14.i8.487
Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions
Jad P AbiMansour, Barham K Abu Dayyeh, Michael J Levy, Andrew C Storm, John A Martin, Bret T Petersen, Ryan J Law, Mark D Topazian, Vinay Chandrasekhara
Jad P AbiMansour, Barham K Abu Dayyeh, Michael J Levy, Andrew C Storm, John A Martin, Bret T Petersen, Ryan J Law, Mark D Topazian, Vinay Chandrasekhara, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: AbiMansour JP collected the data, performed the analysis and wrote the paper; Abu Dayyeh BK, Levy MJ, Storm AC, Martin JA, Petersen BT, Law RJ, and Topazian MD performed the procedures, obtained the data, and critically reviewed the manuscript; and Chandrasekhara VC designed the research and provided supervision, manuscript review, and final approval.
Institutional review board statement: This study was reviewed and approved by the Mayo Clinic Institutional Review Board (IRB No. 20-0055740).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Andrew C Storm is a consultant for Apollo Endosurgery; and received research support from Apollo Endosurgery and Boston Scientific. Ryan J Law is a consultant for ConMed and Medtronic and receives royalties from UpToDate. Bret T Petersen is a consultant for Olympus America and investigator for Boston Scientific and Ambu. Barham K Abu Dayyeh reports consultant roles with Endogenex, Endo-TAGSS, Metamodix, and BFKW; consultant and grant or research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; speaker roles with Olympus, Johnson and Johnson; speaker and grant or research support from Medtronic, Endogastric solutions; and research support from Apollo Endosurgery and Spatz Medical. Vinay Chandrasekhara is a consultant for Covidien LP, is on the advisory board for Interpace Diagnostics, and is a shareholder in Nevakar, Inc. The remaining authors have no conflicts or funding to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vinay Chandrasekhara, FASGE, MD, Associate Professor, Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. chandrasekhara.vinay@mayo.edu
Received: February 14, 2022
Peer-review started: February 14, 2022
First decision: April 5, 2022
Revised: April 19, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 16, 2022
Processing time: 181 Days and 15.4 Hours
Abstract
BACKGROUND

Endoscopic ultrasound (EUS)-guided main pancreatic duct (PD) access may be used when conventional endoscopic retrograde cholangiopancreatography (ERCP) techniques fail. The use of a percutaneous transluminal angioplasty balloon (PTAB), originally developed for vascular interventions, can be used to facilitate transmural (e.g., transgastric) PD access and to dilate high-grade pancreatic strictures.

AIM

To describe the technique, efficacy, and safety of PTABs for EUS-guided PD interventions.

METHODS

Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database. PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire. The primary outcome was technical success. Secondary outcomes included incidence of adverse events (AEs) and need for early reintervention.

RESULTS

A total of 23 patients were identified (48% female, mean age 55.8 years). Chronic pancreatitis was the underlying etiology in 13 (56.5%) patients, surgically altered anatomy (SAA) with stricture in 7 (30.4%), and SAA with post-operative leak in 3 (13.0%). Technical success was achieved in 20 (87%) cases. Overall AE rate was 26% (n = 6). All AEs were mild and included 1 pancreatic duct leak, 2 cases of post-procedure pancreatitis, and 3 admissions for post-procedural pain. No patients required early re-intervention.

CONCLUSION

EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

Keywords: Dilating balloon; Pancreatic duct intervention; Chronic pancreatitis; Anastomotic stricture

Core Tip: Endoscopic ultrasound (EUS)-guided access of the main pancreatic duct (MPD) can be used to perform endotherapy when conventional endoscopic retrograde cholangiopancreatography fails. After access to the MPD is obtained, the tract created between the gastrointestinal lumen and pancreatic duct must be dilated prior to any further intervention. Percutaneous transluminal angioplasty balloons, originally developed for vascular interventions, can be used to access the pancreatic duct effectively and safely, as well as dilate high-grade MPD strictures if needed. Interventional endoscopists should be familiar with these cross-platform balloons as additional tools in the toolbox for EUS-guided MPD endotherapy.