title: An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery.
abstract: OBJECTIVE
  Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy.
  
  
  METHODS
  This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included.
  
  
  RESULTS
  In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P < .001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P < .001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P < .001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.affiliation: Division of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Moreels
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Gulara
authors.initials: G
authors.lastname: Hajijeva
authors.affiliation: Division of Gastroenterology and Hepatology, Municipal Hospital, Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
authors.affiliation: Department of Surgery, Ana Costa Hospital, Santos, Brazil.
authors.forename: Everson L
authors.initials: EL
authors.lastname: Artifon
authors.affiliation: Division of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Divisions of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Barham
authors.initials: B
authors.lastname: Abu Dayyeh
authors.affiliation: Division of Gastroenterology and Hepatology, Municipal Hospital, Gera, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Reichel
authors.affiliation: Department of Surgery, Ana Costa Hospital, Santos, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Vilela
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Haito-Chavez
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Majidah
authors.initials: M
authors.lastname: Bukhari
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Okolo
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Ismail
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects