Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2016; 4(4): 112-117
Published online Apr 16, 2016. doi: 10.12998/wjcc.v4.i4.112
Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent
Arunchai Chang, Pitulak Aswakul, Varayu Prachayakul
Arunchai Chang, Varayu Prachayakul, Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok 10700, Thailand
Pitulak Aswakul, Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok 10120, Thailand
Author contributions: Prachayakul V conceived of and designed the case report; Chang A reviewed the literature and drafted the article; Aswakul P and Prachayakul V revised and approved the final version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Siriraj Institutional Review Board.
Informed consent statement: Any personal item or information will not be published without explicit consent forms the involved persons.
Conflict-of-interest statement: All the authors declare no conflict of interest.
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:
Correspondence to: Varayu Prachayakul, MD, Associate Professor, Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand.
Telephone: +66-818-654646 Fax: +66-241-15013
Received: November 10, 2015
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.

Keywords: Endoscopic ultrasound-guided, Endoscopic ultrasound, Pancreaticogastrostomy, Pancreatic duct drainage, Chronic pancreatitis, Self-expandable metallic stent

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.