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EUS-Guided Pancreatic Duct Cannulation

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Endoscopic ultrasound-guided pancreatic duct drainage is an emerging endoscopic procedure to provide access to and enable interventions in the main pancreatic duct for patients with failed ERCP or with surgically altered anatomy. It is now considered a valid alternative to percutaneous or surgical interventions. Nonetheless, it is technically demanding and carries a notable risk for complications. Appropriate patient selection, careful evaluation of the indication and contraindications, and execution by highly experienced endoscopists are important prerequisites to ensure optimal outcomes.

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References

  1. Amano H, Takada T, Ammori BJ et al (1998) Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study. Hepato-Gastroenterology 45:2382–2387

    CAS  PubMed  Google Scholar 

  2. Artifon ELA, Frazão MSV, Coelho Ferreira F, Otoch JP (2012a) EUS-guided access to dorsal pancreatic duct in a patient with pancreas divisum. Rev Gastroenterol Peru 32:309–311

    Google Scholar 

  3. Artifon ELA, Rebello C, Frazão MSV, Otoch JP (2012b) A novel technique on EUS-guided access to dorsal pancreatic duct in a patient with pancreas divisum. J Interv Gastroenterol 2:94–96. https://doi.org/10.4161/jig.22208

    Article  PubMed  PubMed Central  Google Scholar 

  4. Attam R, Arain M, Trikudanathan G, Freeman ML (2015) EUS-guided pancreatic duct access and wire placement to facilitate dorsal duct cannulation after failed ERCP. Gastrointest Endosc 81:1260. https://doi.org/10.1016/j.gie.2014.07.036

    Article  PubMed  Google Scholar 

  5. Bakker OJ, van Baal MC, van Santvoort HC et al (2011) Endoscopic transpapillary stenting or conservative treatment for pancreatic fistulas in necrotizing pancreatitis: multicenter series and literature review. Ann Surg 253:961–967. https://doi.org/10.1097/SLA.0b013e318212e901

    Article  PubMed  Google Scholar 

  6. Barkay O, Sherman S, McHenry L et al (2010) Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. Gastrointest Endosc 71:1166–1173. https://doi.org/10.1016/j.gie.2009.10.048

    Article  PubMed  Google Scholar 

  7. Bataille L, Deprez P (2002) A new application for therapeutic EUS: main pancreatic duct drainage with a “pancreatic rendezvous technique”. Gastrointest Endosc 55:740–743

    Article  Google Scholar 

  8. Brauer BC, Chen YK, Fukami N, Shah RJ (2009) Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc 70:471–479. https://doi.org/10.1016/j.gie.2008.12.233

    Article  PubMed  Google Scholar 

  9. Brennan PM, Stefaniak T, Palmer KR, Parks RW (2006) Endoscopic transpapillary stenting of pancreatic duct disruption. Dig Surg 23:250–254. https://doi.org/10.1159/000095398

    Article  CAS  PubMed  Google Scholar 

  10. Chen Y-I, Levy MJ, Moreels TG et al (2017) An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 85:170–177. https://doi.org/10.1016/j.gie.2016.07.031

    Article  CAS  PubMed  Google Scholar 

  11. Cooper ST, Malick J, McGrath K et al (2010) EUS-guided rendezvous for the treatment of pancreaticopleural fistula in a patient with chronic pancreatitis and pancreas pseudodivisum. Gastrointest Endosc 71:652–654. https://doi.org/10.1016/j.gie.2009.08.017

    Article  PubMed  Google Scholar 

  12. Devière J (2017) EUS-guided pancreatic duct drainage: a rare indication in need of prospective evidence. Gastrointest Endosc 85:178–180. https://doi.org/10.1016/j.gie.2016.08.041

    Article  PubMed  Google Scholar 

  13. Dhir V, Isayama H, Itoi T et al (2017) Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 29:472–485. https://doi.org/10.1111/den.12818

    Article  PubMed  Google Scholar 

  14. Dumonceau J-M, Delhaye M, Tringali A et al (2012) Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 44:784–800. https://doi.org/10.1055/s-0032-1309840

    Article  PubMed  Google Scholar 

  15. Ergun M, Aouattah T, Gillain C et al (2011) Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy 43:518–525. https://doi.org/10.1055/s-0030-1256333

    Article  CAS  PubMed  Google Scholar 

  16. François E, Kahaleh M, Giovannini M et al (2002) EUS-guided pancreaticogastrostomy. Gastrointest Endosc 56:128–133

    Article  Google Scholar 

  17. Fujii LL, Topazian MD, Abu Dayyeh BK et al (2013) EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc 78:854–864.e1. https://doi.org/10.1016/j.gie.2013.05.016

    Article  PubMed  Google Scholar 

  18. Fujii-Lau LL, Levy MJ (2015) Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Biliary Pancreat Sci 22:51–57. https://doi.org/10.1002/jhbp.187

    Article  Google Scholar 

  19. Giovannini M (2013) EUS-guided pancreatic duct drainage: ready for prime time? Gastrointest Endosc 78:865–867. https://doi.org/10.1016/j.gie.2013.10.019

    Article  PubMed  Google Scholar 

  20. Gleeson FC, Pelaez MC, Petersen BT, Levy MJ (2007) Drainage of an inaccessible main pancreatic duct via EUS-guided transgastric stenting through the minor papilla. Endoscopy 39(Suppl 1):E313–E314. https://doi.org/10.1055/s-2007-966794

    Article  PubMed  Google Scholar 

  21. Gornals J, Consiglieri C, Vida F, Loras C (2016) Endoscopic ultrasound-guided pancreaticogastrostomy using a lumen-apposing metal stent plus a double-pigtail plastic stent. Endoscopy 48:E276–E277. https://doi.org/10.1055/s-0042-113186

    Article  PubMed  Google Scholar 

  22. Gress F, Ikenberry S, Sherman S, Lehman G (1996) Endoscopic ultrasound-directed pancreatography. Gastrointest Endosc 44:736–739

    Article  CAS  Google Scholar 

  23. Haddad LBP, Scatton O, Randone B et al (2009) Pancreatic fistula after pancreaticoduodenectomy: the conservative treatment of choice. HPB 11:203–209. https://doi.org/10.1111/j.1477-2574.2009.00007.x

    Article  PubMed  PubMed Central  Google Scholar 

  24. Harada N, Kouzu T, Arima M et al (1995) Endoscopic ultrasound-guided pancreatography: a case report. Endoscopy 27:612–615. https://doi.org/10.1055/s-2007-1005769

    Article  CAS  PubMed  Google Scholar 

  25. Itoi T, Kikuyama M, Ishii K et al (2011) EUS-guided rendezvous with single-balloon enteroscopy for treatment of stenotic pancreaticojejunal anastomosis in post-Whipple patients (with video). Gastrointest Endosc 73:398–401. https://doi.org/10.1016/j.gie.2010.07.010

    Article  PubMed  Google Scholar 

  26. Itoi T, Kasuya K, Sofuni A et al (2013) Endoscopic ultrasonography-guided pancreatic duct access: techniques and literature review of pancreatography, transmural drainage and rendezvous techniques. Dig Endosc 25:241–252. https://doi.org/10.1111/den.12048

    Article  PubMed  Google Scholar 

  27. Itoi T, Sofuni A, Tsuchiya T et al (2015) Initial evaluation of a new plastic pancreatic duct stent for endoscopic ultrasonography-guided placement. Endoscopy 47:462–465. https://doi.org/10.1055/s-0034-1391083

    Article  PubMed  Google Scholar 

  28. James TW, Baron TH (2018) Antegrade pancreatoscopy via EUS-guided pancreaticogastrostomy allows removal of obstructive pancreatic duct stones. Endosc Int Open 6:E735–E738. https://doi.org/10.1055/a-0607-2484

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jirapinyo P, Lee LS (2016) Endoscopic ultrasound-guided pancreatobiliary endoscopy in surgically altered anatomy. Clin Endosc 49:515–529. https://doi.org/10.5946/ce.2016.144

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jürgensen C, Distler M, Arlt A et al (2019) EUS-guided drainage in the management of postoperative pancreatic leaks and fistulas (with video). Gastrointest Endosc 89:311–319.e1. https://doi.org/10.1016/j.gie.2018.08.046

    Article  PubMed  Google Scholar 

  31. Kahaleh M, Yoshida C, Yeaton P (2003) EUS antegrade pancreatography with gastropancreatic duct stent placement: review of two cases. Gastrointest Endosc 58:919–923

    Article  Google Scholar 

  32. Kahaleh M, Hernandez AJ, Tokar J et al (2006) Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc 64:52–59. https://doi.org/10.1016/j.gie.2006.01.063

    Article  PubMed  Google Scholar 

  33. Kahaleh M, Hernandez AJ, Tokar J et al (2007) EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 65:224–230. https://doi.org/10.1016/j.gie.2006.05.008

    Article  PubMed  Google Scholar 

  34. Kawakubo K, Isayama H, Sasahira N et al (2013) Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes. Surg Endosc 27:3437–3443. https://doi.org/10.1007/s00464-013-2896-5

    Article  PubMed  Google Scholar 

  35. Keenan J, Mallery S, Freeman ML (2007) EUS rendezvous for pancreatic stent placement during endoscopic snare ampullectomy. Gastrointest Endosc 66:850–853. https://doi.org/10.1016/j.gie.2007.01.005

    Article  PubMed  Google Scholar 

  36. Kikuyama M, Itoi T, Ota Y et al (2011) Therapeutic endoscopy for stenotic pancreatodigestive tract anastomosis after pancreatoduodenectomy (with videos). Gastrointest Endosc 73:376–382. https://doi.org/10.1016/j.gie.2010.10.015

    Article  PubMed  Google Scholar 

  37. Kinney TP, Li R, Gupta K et al (2009) Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access. Endoscopy 41:898–901. https://doi.org/10.1055/s-0029-1215081

    Article  CAS  PubMed  Google Scholar 

  38. Koito K, Nagakawa T, Murashima Y et al (1995) Endoscopic ultrasonographic-guided punctured pancreatic ductography: an initial and successful trial. Abdom Imaging 20:222–224

    Article  CAS  Google Scholar 

  39. Kurihara T, Itoi T, Sofuni A et al (2013) Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc 25(Suppl 2):109–116. https://doi.org/10.1111/den.12100

    Article  PubMed  Google Scholar 

  40. Mallery S, Matlock J, Freeman ML (2004) EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc 59:100–107

    Article  Google Scholar 

  41. Matsunami Y, Itoi T, Sofuni A et al (2018) Evaluation of a new stent for EUS-guided pancreatic duct drainage: long-term follow-up outcome. Endosc Int Open 6:E505–E512. https://doi.org/10.1055/s-0044-101753

    Article  PubMed  PubMed Central  Google Scholar 

  42. Minaga K, Kitano M (2018) Recent advances in endoscopic ultrasound-guided biliary drainage. Dig Endosc 30:38–47. https://doi.org/10.1111/den.12910

    Article  PubMed  Google Scholar 

  43. Minami K, Iwasaki E, Itoi T et al (2017) Successful EUS-guided nondilated pancreatic duct stent placement in patient with refractory pancreatic fistula after pancreaticoduodenectomy. VideoGIE 2:315–316. https://doi.org/10.1016/j.vgie.2017.07.012

    Article  PubMed  PubMed Central  Google Scholar 

  44. Morgan KA, Fontenot BB, Harvey NR, Adams DB (2010) Revision of anastomotic stenosis after pancreatic head resection for chronic pancreatitis: is it futile? HPB 12:211–216. https://doi.org/10.1111/j.1477-2574.2009.00154.x

    Article  PubMed  PubMed Central  Google Scholar 

  45. Nakai Y, Isayama H, Umefune G et al (2016) Percutaneous transhepatic cholangioscopy-assisted repositioning of misplaced endoscopic ultrasound-guided pancreatic duct stent. Endoscopy 48(Suppl 1):E129–E130. https://doi.org/10.1055/s-0042-105210

    Article  PubMed  Google Scholar 

  46. Ogura T, Onda S, Sano T et al (2015) Endoscopic ultrasound-guided pancreatic duct drainage using antegrade stenting. Endoscopy 47:E161–E162. https://doi.org/10.1055/s-0034-1391422

    Article  PubMed  Google Scholar 

  47. Oh D, Park DH, Cho MK et al (2016) Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc 83:366–373.e2. https://doi.org/10.1016/j.gie.2015.07.015

    Article  PubMed  Google Scholar 

  48. Papachristou GI, Gleeson FC, Petersen BT, Levy MJ (2007) Pancreatic endoscopic ultrasound-assisted rendezvous procedure to facilitate drainage of nondilated pancreatic ducts. Endoscopy 39(Suppl 1):E324–E325. https://doi.org/10.1055/s-2007-966805

    Article  PubMed  Google Scholar 

  49. Park DH, Jang JW, Lee SS et al (2011) EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 74:1276–1284. https://doi.org/10.1016/j.gie.2011.07.054

    Article  PubMed  Google Scholar 

  50. Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K et al (2007) Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 11:1704–1711. https://doi.org/10.1007/s11605-007-0369-7

    Article  PubMed  Google Scholar 

  51. Ryou M, Mullady DK, Dimaio CJ et al (2010) Pancreatic antegrade needle-knife (PANK) for treatment of symptomatic pancreatic duct obstruction in Whipple patients (with video). Gastrointest Endosc 72:1081–1088. https://doi.org/10.1016/j.gie.2010.07.017

    Article  PubMed  Google Scholar 

  52. Săftoiu A, Dumitrescu D, Stoica M et al (2007) EUS-assisted rendezvous stenting of the pancreatic duct for chronic calcifying pancreatitis with multiple pseudocysts. Pancreatology 7:74–79. https://doi.org/10.1159/000101881

    Article  PubMed  Google Scholar 

  53. Shah JN, Marson F, Weilert F et al (2012) Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 75:56–64. https://doi.org/10.1016/j.gie.2011.08.032

    Article  PubMed  Google Scholar 

  54. Sharaiha RZ, Khan MA, Kamal F et al (2017) Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 85:904–914. https://doi.org/10.1016/j.gie.2016.12.023

    Article  PubMed  Google Scholar 

  55. Takano S, Ito Y, Oishi H et al (2000) A retrospective analysis of 88 patients with pancreaticogastrostomy after pancreaticoduodenectomy. Hepato-Gastroenterology 47:1454–1457

    CAS  PubMed  Google Scholar 

  56. Takikawa T, Kanno A, Masamune A et al (2013) Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy. World J Gastroenterol 19:5182–5186. https://doi.org/10.3748/wjg.v19.i31.5182

    Article  PubMed  PubMed Central  Google Scholar 

  57. Tessier G, Bories E, Arvanitakis M et al (2007) EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 65:233–241. https://doi.org/10.1016/j.gie.2006.06.029

    Article  PubMed  Google Scholar 

  58. Tyberg A, Sharaiha RZ, Kedia P et al (2017) EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 85:164–169. https://doi.org/10.1016/j.gie.2016.07.030

    Article  PubMed  Google Scholar 

  59. Uche-Anya EN, Packey CD, Khan AS, Sethi A (2018) EUS-guided pancreatic duct puncture for difficult cannulation of stenosed pancreaticojejunostomy. Dig Dis Sci 63:268–269. https://doi.org/10.1007/s10620-017-4858-6

    Article  PubMed  Google Scholar 

  60. Uchida D, Kato H, Saragai Y et al (2018) Indications for endoscopic ultrasound-guided pancreatic drainage: for benign or malignant cases? Can J Gastroenterol Hepatol 2018:1–6. https://doi.org/10.1155/2018/8216109

    Article  Google Scholar 

  61. Varadarajulu S, Noone TC, Tutuian R et al (2005) Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc 61:568–575

    Article  Google Scholar 

  62. Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E et al (2012) Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 76:1133–1141. https://doi.org/10.1016/j.gie.2012.08.001

    Article  PubMed  Google Scholar 

  63. Widmer J, Sharaiha RZ, Kahaleh M (2013) Endoscopic ultrasonography-guided drainage of the pancreatic duct. Gastrointest Endosc Clin N Am 23:847–861. https://doi.org/10.1016/j.giec.2013.06.011

    Article  PubMed  Google Scholar 

  64. Will U, Meyer F, Manger T, Wanzar I (2005) Endoscopic ultrasound-assisted rendezvous maneuver to achieve pancreatic duct drainage in obstructive chronic pancreatitis. Endoscopy 37:171–173. https://doi.org/10.1055/s-2004-826151

    Article  CAS  PubMed  Google Scholar 

  65. Will U, Fueldner F, Thieme A-K et al (2007) Transgastric pancreatography and EUS-guided drainage of the pancreatic duct. J Hepato-Biliary-Pancreat Surg 14:377–382. https://doi.org/10.1007/s00534-006-1139-8

    Article  Google Scholar 

  66. 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 J Gastroenterol 21:13140–13151. https://doi.org/10.3748/wjg.v21.i46.13140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal

    Sara Campos

  2. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

    Marco J. Bruno

Authors
  1. Sara Campos
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  2. Marco J. Bruno
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Correspondence to Marco J. Bruno .

Editor information

Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Campos, S., Bruno, M.J. (2020). EUS-Guided Pancreatic Duct Cannulation. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_72-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_72-1

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  1. Latest

    EUS-Guided Pancreatic Duct Cannulation
    Published:
    04 December 2020

    DOI: https://doi.org/10.1007/978-3-030-29964-4_72-2

  2. Original

    EUS-Guided Pancreatic Duct Cannulation
    Published:
    29 August 2020

    DOI: https://doi.org/10.1007/978-3-030-29964-4_72-1

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