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Anterograde Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: A Technical Review

  • Matthew R. Krafft
  • John Y. NasrEmail author
Review

Abstract

The advancement of pancreatic endotherapy has increased the availability of minimally invasive endoscopic pancreatic ductal drainage techniques. In this regard, familiarity with endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is critical for treatment of obstructed pancreatic ductal systems, especially in nonsurgical candidates and in patients desiring a minimally invasive approach. Two distinct forms of EUS-PDD exist, viz. rendezvous-assisted endoscopic retrograde pancreatography (rendezvous-assisted ERP) and anterograde EUS-PDD. Anterograde EUS-PDD refers to transmural anterograde passage of a pancreatic drainage catheter or stent directly into the main pancreatic duct, through either the gastric or enteral wall. Rendezvous-assisted ERP should be attempted after failed conventional ERP, and anterograde EUS-PDD should be considered if rendezvous-assisted ERP fails or is not technically feasible. Common clinical scenarios that fulfil these conditions are chronic pancreatitis with high-grade main pancreatic duct obstruction, surgically altered anatomy with ductal/anastomotic obstruction, pancreas divisum, and disconnected pancreatic duct syndrome. The focus of this review article is anterograde EUS-PDD and its indications, technique, and outcomes. It also provides a summary of our own experience with this procedure, and a video demonstration of the technique.

Keywords

Anterograde endoscopic ultrasound-guided pancreatic duct drainage Pancreaticogastrostomy Endoscopic ultrasound Chronic pancreatitis Pancreaticojejunostomy Disconnected pancreatic duct syndrome 

Notes

Compliance with ethical standards

Conflict of interest

Drs. Matthew Krafft and John Nasr report no disclosures related to industry.

Supplementary material

Video 1

Step-by-step video, with narration, of anterograde EUS-PDD. This video was made during the index procedure for case (patient) number 1, shown in Table 2 (MP4 131,466 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Digestive DiseasesWest Virginia University MedicineMorgantownUSA

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