Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook

As an innovative endoscopic intervention, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) demonstrates significant clinical value in resolving pancreatic ductal hypertension syndrome. By integrating real-time ultrasound guidance with catheter-based intervention techniques, this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed. Current evidence indicates that EUS-PD achieves technical success rates ranging from 82% to 95% in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures, with an overall complication rate (15%-20%) substantially lower than surgical interventions. Compared to conventional imaging modalities, EUS-PD offers superior anatomical visualization capabilities: Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches, while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures (sensitivity 91% vs 73%, P < 0.05). Nevertheless, technical challenges persist, including difficult ductal puncture localization (particularly in pancreatic head lesions), complex guidewire axial control, and postoperative pancreatic fistula risks (7%-12%). This review systematically examines the clinical indications/contraindications, procedural protocols, device selection criteria, and management strategies for early/late complications associated with EUS-PD. Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches. Advancements in auxiliary technologies (e.g., three-dimensional elastography, AI-assisted navigation) and multidisciplinary team collaboration are pivotal to developing standardized protocols. We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems. Such initiatives will facilitate the clinical transformation of EUS-PD from an "alternative option" to a "preferred strategy", ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.