Published online Apr 16, 2016. doi: 10.12998/wjcc.v4.i4.112
Peer-review started: November 11, 2015
First decision: December 22, 2015
Revised: January 12, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: April 16, 2016
One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis.
Core tip: Endoscopic treatment for chronic pancreatitis is one of the most challenging advanced therapeutic interventions applied in clinical practice. While endoscopic retrograde pancreaticography remains the preferred treatment option, alternative therapeutic approaches are available for application upon failure of the first-line approach, including endoscopic ultrasound (EUS)-guided pancreatic interventions, radiological interventions, or surgery. Here, we describe a case of chronic pancreatitis that failed first-line therapy and was effectively and safely resolved by EUS-guided pancreaticogastrostomy using a biliary-type, fully covered, self-expandable metallic stent.