title: Gastro-pancreaticojejunostomy for treatment of pancreatic ductal obstruction in a post-Whipple procedure patient.
abstract: We report a case of a woman with a medical history of classic Whipple surgery who underwent endoscopic ultrasound (EUS)-guided pancreatic drainage due to smouldering acute pancreatitis secondary to an obstructing pancreatic ductal stone. A gastro-pancreaticojejunostomy anastomosis was created anterogradely, with dilation of both the anastomoses in the same procedure, with subsequent decompression of the pancreatic duct. Endoscopic retrograde pancreatography (ERP) is often impossible to perform in patients with post-Whipple procedure anatomy due to inaccessibility to the pancreaticojejunostomy anastomosis. EUS-guided pancreatic drainage may be offered in these patients in whom the pancreatic duct cannot be accessed at ERP. It has been used as a platform for access to and drainage of the pancreatic duct either by rendezvous or transmural drainage. However, only one of four patients achieve successful completion of the rendezvous procedure. There are limited data regarding safety and long-term outcome of this procedure, as well as scant guidelines on the optimal time for leaving stents in place. We believe definitive endoscopic therapy should be attempted, whenever possible, after relief of obstruction. In our case, we expect that stent occlusion is inevitable and that long-term drainage is possible due to drainage occurring between the stent and the stone.
authors.affiliation: Gastroenterology Department , Centro Hospitalar São João , Porto , Portugal ; Division of Gastroenterology and Hepatology , University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodrigues-Pinto
authors.affiliation: Division of Gastroenterology and Hepatology , University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Grimm
authors.affiliation: Division of Gastroenterology and Hepatology , University of North Carolina , Chapel Hill, North Carolina , USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
keywords: ENDOSCOPIC RETROGRADE PANCREATOGRAPHY; ENDOSCOPIC ULTRASONOGRAPHY; PANCREATIC DISORDERS