EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts.
BACKGROUND
EUS-guided pancreaticogastrostomy (EPG) has been reported as an alternative to surgery in cases of pancreatic stricture where ERCP is unsuccessful.


OBJECTIVE
We analyzed our 3-year experience with this innovative technique.


METHODS
Patients with failed ERCP for pancreatic drainage were offered EPG over a 3-year period and were followed up prospectively in terms of clinical and radiologic response.


METHODS
Tertiary care center offering ERCP and interventional EUS.


METHODS
Thirteen patients were included in this study. Seven had surgical diversion Six patients had unaltered enteral anatomy and stricture related to chronic pancreatitis (3), gallstone pancreatitis (2), and intraductal pancreatic mucinous neoplasm (1).


METHODS
EUS-guided puncture and opacification of the pancreatic duct was performed, creating a transgastric fistula with placement of a guidewire into the main pancreatic duct and subsequent ductal decompression with a plastic endoprosthesis.


METHODS
Mean main pancreatic duct size, pain score, and weight before and after intervention.


RESULTS
Ten patients had successful endoprosthesis placement across the pancreaticogastric fistula. One patient underwent brush cytologic study, which diagnosed pancreatic malignancy, and underwent surgical resection. After a mean follow-up of 14 months, the mean pancreatic duct size in treated patients decreased from 4.6 to 3.0 mm (P = .01); the pain score decreased from 7.3 to 3.6 (P = .01). Complications included one case of bleeding requiring hemoclip placement and 1 case of contained perforation.


CONCLUSIONS
Pilot study from a single center.


CONCLUSIONS
EPG is a safe and feasible alternative to surgical intervention in this subgroup of patients where conventional ERCP is not possible.
Kahaleh
Michel
M
Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
Hernandez
Alfredo J
AJ
Tokar
Jeffrey
J
Adams
Reid B
RB
Shami
Vanessa M
VM
Yeaton
Paul
P
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000628:therapy*; D010865:Pilot Projects; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents; D016896:Treatment Outcome