title: Therapeutic endoscopy for stenotic pancreatodigestive tract anastomosis after pancreatoduodenectomy (with videos).
abstract: BACKGROUND
  Pancreatodigestive tract anastomotic site stenosis is a problematic complication after pancreatoduodenectomy.
  
  
  OBJECTIVE
  We evaluated the feasibility and efficacy of endoscopic treatments for a stenotic pancreatodigestive tract anastomosis.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Endoscopic units of a university-affiliated hospital and a general hospital.
  
  
  METHODS
  Fourteen patients with recurrent pancreatitis (n=10) and pancreatic fluid fistula (n=4) after anatomy-altering surgery with pancreatodigestive tract anastomosis.
  
  
  METHODS
  The initial ERCP included obtaining a pancreatogram, introducing a 0.025-inch guidewire through the anastomosis, along which a 5F plastic stent or nasopancreatic drain was inserted. If initial ERCP failed, we attempted EUS-guided rendezvous, with a guidewire passed antegrade from the main pancreatic duct across the stenotic anastomosis.
  
  
  METHODS
  Rates of successful intervention and clinical relief.
  
  
  RESULTS
  The initial intervention was successfully achieved in 6 of 14 patients (38%). Of the 6 patients with successful therapeutic endoscopies, 4 (66.7%) and 2 (25.0%) had undergone a previous pancreatogastrostomy or pancreatojejunostomy, respectively. Eight patients with an initial unsuccessful intervention successfully underwent a second intervention using an EUS-guided or US-guided rendezvous method. Finally, stenosis was relieved in all patients with either the retrograde placement of a pancreatic duct stent across the stenosis of an anastomotic site or antegrade percutaneous bougienage of the stenotic anastomosis.
  
  
  CONCLUSIONS
  Small sample size and lack of control patients.
  
  
  CONCLUSIONS
  Endoscopic treatment of stenotic pancreatodigestive tract anastomosis for transanastomotic pancreatic juice drainage is safe and feasible.
authors.affiliation: Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kikuyama
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ota
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Matsumura
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome