title: Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS)-guided pancreatic drainage has been advocated as a rescue treatment for management of patients in whom retrograde access to the pancreatic duct (PD) is technically unsuccessful. The aim of the present study was to evaluate the feasibility and efficacy of EUS-guided drainage for failed endoscopic retrograde cholangiopancreatography.
  
  
  METHODS
  A total of 17 EUS-guided PD drainage (EUS-PD) procedures were carried out in 14 patients (age: mean 64.6 years, range 54-81 years, eight men).
  
  
  RESULTS
  The rendezvous technique was successful in 11 of 17 procedures (64.7%). Three of five patients with an unsuccessful rendezvous technique successfully underwent EUS-PD stenting (7-Fr plastic stent [two cases], 5-Fr endoscopic nasobiliary drainage [one case]). In the two remaining patients, puncture and pancreatography were successful; however, antegrade passage of the guidewire failed.
  
  
  CONCLUSIONS
  EUS-guided decompression of PD is a feasible and effective treatment for the management of symptomatic high-pressure PD due to stricture of the PD and/or stenotic pancreatodigestive anastomosis. However, this procedure is technically challenging, has a high rate of complications, and should be done only at tertiary-care centers.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. kurihara@tokyo-med.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome