title: Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy.
abstract: The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7. Thereafter, she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy. She developed a pancreatic fistula and an intra-abdominal abscess after the operation. These complications were improved by percutaneous abscess drainage and antibiotic therapy. However, upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy. Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography, we tried an endoscopic ultrasonography (EUS) guided rendezvous technique for pancreatic duct drainage. After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle, the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis. We changed the echoendoscope to an oblique-viewing endoscope, then grasped the guidewire and withdrew it through the scope. The stenosis of the pancreaticojejunostomy was dilated up to 4 mm, and a pancreatic stent was put in place. Though the pancreatic stent was removed after three months, the patient remained symptom-free. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan.
authors: Tetsuya
authors: T
authors: Takikawa
authors: Atsushi
authors: A
authors: Kanno
authors: Atsushi
authors: A
authors: Masamune
authors: Shin
authors: S
authors: Hamada
authors: Eriko
authors: E
authors: Nakano
authors: Shin
authors: S
authors: Miura
authors: Hiroyuki
authors: H
authors: Ariga
authors: Jun
authors: J
authors: Unno
authors: Kiyoshi
authors: K
authors: Kume
authors: Kazuhiro
authors: K
authors: Kikuta
authors: Morihisa
authors: M
authors: Hirota
authors: Hiroshi
authors: H
authors: Yoshida
authors: Yu
authors: Y
authors: Katayose
authors: Michiaki
authors: M
authors: Unno
authors: Tooru
authors: T
authors: Shimosegawa
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic; D004108:Dilatation, Pathologic; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011677:Punctures; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Balloon dilatation; Endoscopic ultrasound-guided fine needle aspiration; Pancreaticobiliary maljunction; Pancreaticoduodenectomy; Pancreatitis; Postoperative complication
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