title: Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct.
abstract: OBJECTIVE
  To evaluate the use of translumenal pancreatography with placement of endoscopic ultrasonography (EUS)-guided drainage of the pancreatic duct.
  
  
  METHODS
  This study enrolled all consecutive patients between June 2002 and April 2014 who underwent EUS-guided pancreatography and subsequent placement of a drain and had symptomatic retention of fluid in the pancreatic duct after one or more previous unsuccessful attempts at endoscopic retrograde cannulation of the pancreatic duct. In all, 94 patients underwent 111 interventions with one of three different approaches: (1) EUS-endoscopic retrograde drainage with a rendezvous technique; (2) EUS-guided drainage of the pancreatic duct; and (3) EUS-guided, internal, antegrade drainage of the pancreatic duct.
  
  
  RESULTS
  The mean duration of the interventions was 21 min (range, 15-69 min). Mean patient age was 54 years (range, 28-87 years); the M:F sex ratio was 60:34. The technical success rate was 100%, achieving puncture of the pancreatic duct including pancreatography in 94/94 patients. In patients requiring drainage, initial placement of a drain was successful in 47/83 patients (56.6%). Of these, 26 patients underwent transgastric/transbulbar positioning of a stent for retrograde drainage; plastic prostheses were used in 11 and metal stents in 12. A ring drain (antegrade internal drainage) was placed in three of these 26 patients because of anastomotic stenosis after a previous surgical intervention. The remaining 21 patients with successful drain placement had transpapillary drains using the rendezvous technique; the majority (n = 19) received plastic prostheses, and only two received metal stents (covered self-expanding metal stents). The median follow-up time in the 21 patients with transpapillary drainage was 28 mo (range, 1-79 mo), while that of the 26 patients with successful transgastric/transduodenal drainage was 9.5 mo (range, 1-82 mo). Clinical success, as indicated by reduced or absence of further pain after the EUS-guided intervention was achieved in 68/83 patients (81.9%), including several who improved without drainage, but with manipulation of the access route.
  
  
  CONCLUSIONS
  EUS-guided drainage of the pancreatic duct is a safe, feasible alternative to endoscopic retrograde drainage when the papilla cannot be reached endoscopically or catheterized.
authors.affiliation: Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
authors.affiliation: Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reichel
authors.affiliation: Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Fueldner
authors.affiliation: Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*
keywords: Clinical success; Endoscopic ultrasonography; Endoscopic ultrasonography-guided drainage of the pancreatic duct; Endoscopic ultrasonography-guided transmural pancreatography; Metal stent; Plastic prosthesis; Prospective, long-term, single-center study; Technical success