title: EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study.
abstract: OBJECTIVE
  Endoscopic retrograde pancreatography (ERP) is considered first-line therapy for management of symptomatic pancreatic duct obstruction. Technical failure with ERP occurs when the main pancreatic duct cannot be cannulated. EUS-guided drainage of the pancreatic duct is a minimally invasive alternative to surgery for failed conventional ERP. We present an international, multicenter study on the safety and efficacy of EUS-guided pancreatic drainage (EUS-PD) for patients who fail conventional endoscopic therapy.
  
  
  METHODS
  Between January 2006 and December 2015, 80 patients underwent EUS-PD at 4 academic centers in 3 countries. Patient demographics, medical history, procedure data, and follow-up clinical data were collected. Technical success was defined as successful pancreatic duct drainage with stent placement. Clinical success was defined as resolution or improvement of symptoms or improvement on postprocedure imaging.
  
  
  RESULTS
  Eighty patients (62.5% men; mean age, 58.2 ± 15.5 years) were included. All patients had attempted ERP and/or extracorporeal lithotripsy if needed before EUS-PD. Technical success was achieved in 89% of patients (n = 71). Clinical success was achieved in 81% of patients overall (65/80) and in 92% of patients who achieved technical success (65/71). Immediate adverse events occurred in 20% of patients (n = 16) and delayed adverse events occurred in 11% of patients (n = 9).
  
  
  CONCLUSIONS
  With appropriate endoscopic expertise, EUS-PD offers a minimally invasive, more effective, and safer alternative to some surgical PD procedures. Prospective studies are needed to evaluate long-term outcomes. (Clinical trial registration number: NCT01522573.).
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology, Methodist Hospital, Dallas, Texas, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kumta
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
authors.forename: Everson
authors.initials: E
authors.lastname: Artifon
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery*; D015607:Stents; D017211:Treatment Failure; D018084:Ultrasonography, Interventional / Q000009:adverse effects