Endoscopic Ultrasound-Guided Pancreatic Duct Drainage

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Anatomy

Background:

• Pancreatic duct (PD) drainage is crucial when the papilla or anastomosis is inaccessible, particularly for patients unsuitable for surgery.
• Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) provides an alternative approach in such challenging cases.
• Two primary EUS-PDD techniques exist: EUS-assisted pancreatic rendezvous (EUS-PRV) and EUS-guided pancreaticogastrostomy (EUS-PG).

Purpose of the Study:

• To review the techniques, outcomes, and considerations for EUS-PDD.
• To compare the applicability of EUS-PRV and EUS-PG in different anatomical scenarios.
• To highlight the importance of a multidisciplinary approach in managing PD drainage.

Main Methods:

• Review of EUS-PDD techniques, including EUS-PRV and EUS-PG.
• Analysis of technical and clinical success rates reported in the literature.
• Discussion of adverse event profiles and patient selection criteria.

Main Results:

• Technical and clinical success rates for EUS-PDD range widely from 79% to 100%.
• Adverse events associated with EUS-PDD occur in approximately 20% of cases.
• EUS-PRV is suitable for accessible papilla/anastomosis, while EUS-PG is effective for altered foregut anatomy.

Conclusions:

• EUS-PDD is a viable option for pancreatic duct decompression when conventional methods are not feasible.
• Patient-specific factors, including anatomy and clinical goals, dictate the choice between EUS-PRV and EUS-PG.
• Collaborative decision-making among gastroenterology, surgery, and interventional radiology is essential for optimal patient management.