title: EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience.
abstract: BACKGROUND
  EUS can provide access to the main pancreatic duct (MPD) for therapeutic intervention. The long-term clinical success of EUS-guided MPD interventions is unknown.
  
  
  OBJECTIVE
  To determine technical and clinical success rates, predictors of success, and long-term outcomes of EUS-guided MPD intervention.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  Forty-five patients.
  
  
  METHODS
  EUS-guided MPD stent retrieval or placement.
  
  
  METHODS
  Technical and clinical success rates, adverse events, and long-term clinical outcomes.
  
  
  RESULTS
  Among the 45 patients, 37 had undergone failed ERCP, and 29 had surgically altered anatomy. Median follow-up after initial EUS-guided intervention was 23 months. Two patients underwent EUS for stent removal, and EUS-guided MPD stent placement was attempted in 43 patients. Technical success was achieved in 32 of 43 patients (74%) with antegrade (n = 18) or retrograde (n = 14) stent insertion. Serious adverse events occurred in 3 patients (6%). Patients underwent a median of 2 (range 1-6) follow-up procedures for revision or removal of stents, without adverse events. Complete symptom resolution occurred in 24 of 29 patients (83%) while stents were in place, including all 6 with nondilated ducts. Stents were removed in 23 patients, who were then followed for an additional median of 32 months; 4 patients had recurrent symptoms. Among the 11 failed cases, most had persistent symptoms or required surgery.
  
  
  CONCLUSIONS
  Retrospective study design, individualized patient management.
  
  
  CONCLUSIONS
  EUS-guided MPD intervention is feasible and safe, with long-term clinical success in the majority of patients. EUS provides important treatment options, particularly in patients who would otherwise undergo surgery.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Larissa L
authors.initials: LL
authors.lastname: Fujii
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Barham K
authors.initials: BK
authors.lastname: Abu Dayyeh
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Ferga C
authors.initials: FC
authors.lastname: Gleeson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Randall K
authors.initials: RK
authors.lastname: Pearson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Truty
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Santhi S
authors.initials: SS
authors.lastname: Vege
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D018084:Ultrasonography, Interventional / Q000009:adverse effects
keywords: ERP; MPD; endoscopic retrograde pancreatography; main pancreatic duct