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Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct.
World J Gastroenterol. 2015 Dec 14; 21(46):13140-51.WJ

Abstract

AIM

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.

CONCLUSION

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+Show Affiliations

Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.Uwe Will, Andreas Reichel, Frank Fueldner, Department of Internal Medicine III (Gastroenterology and Hepatology), Municipal Hospital (SRH Waldklinikum GmbH), 07548 Gera, Germany.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26674313

Citation

Will, Uwe, et al. "Endoscopic Ultrasonography-guided Drainage for Patients With Symptomatic Obstruction and Enlargement of the Pancreatic Duct." World Journal of Gastroenterology, vol. 21, no. 46, 2015, pp. 13140-51.
Will U, Reichel A, Fueldner F, et al. Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. World J Gastroenterol. 2015;21(46):13140-51.
Will, U., Reichel, A., Fueldner, F., & Meyer, F. (2015). Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. World Journal of Gastroenterology, 21(46), 13140-51. https://doi.org/10.3748/wjg.v21.i46.13140
Will U, et al. Endoscopic Ultrasonography-guided Drainage for Patients With Symptomatic Obstruction and Enlargement of the Pancreatic Duct. World J Gastroenterol. 2015 Dec 14;21(46):13140-51. PubMed PMID: 26674313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. AU - Will,Uwe, AU - Reichel,Andreas, AU - Fueldner,Frank, AU - Meyer,Frank, PY - 2015/02/03/received PY - 2015/06/17/revised PY - 2015/08/28/accepted PY - 2015/12/18/entrez PY - 2015/12/18/pubmed PY - 2016/11/8/medline KW - Clinical success KW - Endoscopic ultrasonography KW - Endoscopic ultrasonography-guided drainage of the pancreatic duct KW - Endoscopic ultrasonography-guided transmural pancreatography KW - Metal stent KW - Plastic prosthesis KW - Prospective, long-term, single-center study KW - Technical success SP - 13140 EP - 51 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 21 IS - 46 N2 - AIM: 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. CONCLUSION: 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. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/26674313/Endoscopic_ultrasonography_guided_drainage_for_patients_with_symptomatic_obstruction_and_enlargement_of_the_pancreatic_duct_ L2 - http://www.wjgnet.com/1007-9327/full/v21/i46/13140.htm DB - PRIME DP - Unbound Medicine ER -