Endoscopic endgame for obstructive pancreatopathy: outcomes of anterograde EUS-guided pancreatic duct drainage. A dual-center study

      Background and Aims

      Anterograde endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) refers to transmural drainage of the main pancreatic duct via an endoprosthesis passed anterograde through the gastric (or intestinal) wall. Anterograde EUS-PDD is a rescue procedure for recalcitrant cases of benign obstructive pancreatopathy.


      We conducted a dual-center retrospective chart review of 28 patients (mean age, 59 years; 50% female) who underwent attempted anterograde EUS-PDD between April 2016 and September 2019 for chronic pancreatitis (CP) (93%) or pancreaticojejunostomy stenosis (PJS) after Whipple resection (7%). The study endpoint was achievement of transpapillary/transanastomotic drainage (definitive therapy).


      Gastropancreaticoenterostomy (ring drainage, definitive therapy) was successfully performed during the index procedure in the 2 patients with PJS (technical success, 100%). Clinical success was 100% in the 2 ring drainage recipients during a mean 18-month follow-up period. The remaining 26 patients with CP underwent attempted pancreaticogastrostomy (PG) with 81% technical success, 75% clinical success, and 15% adverse events (AEs). Repeat endoscopic transmural interventions were performed in the 15 patients with clinical success after PG creation. Definitive therapy transpired in all 15 patients after a median 1 repeat procedure per patient. Clinical success after definitive therapy was maintained in all 15 patients (100%) during a median 4.5-month follow-up.


      In agreement with previous studies, our study showed mild to moderately high rates of technical failure (19%), clinical failure (25%), and AEs (15%) during index drainage (PG creation). Among patients with CP with both technical and clinical success after index PG creation (n = 15), 100% definitive therapy was achieved and clinical outcomes were excellent (100% clinical success, 0% AEs).

      Graphical abstract


      AE (adverse event), CP (chronic pancreatitis), EA-ERP (enteroscopy-assisted endoscopic retrograde pancreatography), ECE-LAMS (electrocautery-enhanced lumen-apposing metal stent), ERP (endoscopic retrograde pancreatography), EUS-PDD (endoscopic ultrasound-guided pancreatic duct drainage), IQR (interquartile range), MPD (main pancreatic duct), PG (pancreaticogastrostomy), PJS (pancreaticojejunostomy stenosis), TMP-EHL (transmural (anterograde) pancreatoscopy with electrohydraulic lithotripsy)
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      Linked Article

      • EUS-directed pancreatic duct drainage: Mainstream miracle or proceed with caution?
        Gastrointestinal EndoscopyVol. 92Issue 5
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          Abdominal pain is the foremost adverse event (AE) of chronic pancreatitis (CP). The mechanism of pain in CP is incompletely understood and likely multifactorial, including mechanical (intraductal pressure/obstruction), inflammatory, malabsorptive, and neurogenic/neuropathic changes in the pancreas and surrounding organs.1 In addition, patients with CP can have nonvisceral pain associated with high levels of psychologic stress. The intensity of pain and frequency of pain attacks compromise the quality of life in CP patients.
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