title: EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts.
abstract: 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.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Hernandez
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
mesh_terms: 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