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Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy
Tetsuya Takikawa1, Atsushi Kanno, Atsushi Masamune
1Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan.
Insights
Endoscopic ultrasonography (EUS)-guided rendezvous technique successfully treated pancreatic duct stenosis after surgery. This minimally invasive approach provided effective pancreatic duct drainage, resolving patient symptoms.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Complications
Background:
- Congenital biliary dilatation treated with Roux-en-Y hepaticojejunostomy can lead to complications like pancreaticobiliary maljunction.
- Recurrent pancreatitis post-pancreaticoduodenectomy necessitates management of pancreaticojejunostomy stenosis.
Observation:
- A 30-year-old female presented with persistent abdominal discomfort and elevated pancreatic enzymes due to pancreaticojejunostomy stenosis.
- Endoscopic retrograde cholangiopancreatography failed to dilate the stenotic anastomosis.
Findings:
- An endoscopic ultrasonography (EUS)-guided rendezvous technique was employed for pancreatic duct drainage.
- Successful transgastric puncture, guidewire insertion, and dilation of the stenotic pancreaticojejunostomy to 4 mm were achieved.
- A pancreatic stent was placed, and the patient remained symptom-free after its removal.
Implications:
- EUS-guided rendezvous technique offers a viable treatment option for refractory pancreaticojejunostomy stenosis.
- This technique provides minimally invasive pancreatic duct drainage, improving outcomes after complex pancreatic surgery.
- Successful management of post-surgical stenosis can prevent recurrent pancreatitis and associated complications.
Abstract:
The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7. Thereafter, she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy. She developed a pancreatic fistula and an intra-abdominal abscess after the operation. These complications were improved by percutaneous abscess drainage and antibiotic therapy. However, upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy. Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography, we tried an endoscopic ultrasonography (EUS) guided rendezvous technique for pancreatic duct drainage. After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle, the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis. We changed the echoendoscope to an oblique-viewing endoscope, then grasped the guidewire and withdrew it through the scope. The stenosis of the pancreaticojejunostomy was dilated up to 4 mm, and a pancreatic stent was put in place. Though the pancreatic stent was removed after three months, the patient remained symptom-free. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.
