EUS-guided pancreatic duct drainage-technical tips and outcomes: narrative review

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is becoming an alternative treatment in patients with difficult retrograde access to the pancreatic duct due to difficulty in cannulation or surgically altered anatomy. This is narrative review for technical tips and outcomes for EUS-PDD. EUS-PDD is performed via one of two approaches: EUS-guided rendezvous and EUS-guided transmural drainage and involves the insertion of plastic or metal stents. While the use of plastic has been extensively described, fully covered self-expandable metal stents were reported in only six studies, and with a small number of patients. A meta-analysis including 27 trials and 902 patients reported technical success, clinical success, and adverse event (AE) rates of 89%, 88%, and 17%, respectively. The most common AE for post-EUS-PDD was acute pancreatitis, which occurred at a rate of 3%. The cumulative rates of bleeding, perforation, pancreatic leak, and infection were 2%, 2%, 1%, and 1%, respectively. The re-intervention rate due to stent dislocation, occlusion, or other reasons was 19%. In cases of surgically altered anatomy, the EUS-guided approach is significantly superior to the enteroscopy-guided approach with regard to pancreatic duct opacification (87% vs 30%; p < 0.001), cannulation success (79% vs 26%; p < 0.001), stent placement (72% vs 20%; p < 0.001), and clinical outcomes (79% vs 19%; p < 0.001), suggesting that EUS-PDD is acceptable as the first option in cases of surgically altered anatomy. Most reports on EUS‑PDD, however, evaluated only a small number of patients, and there are only few long-term follow-up studies. Further prospective studies are needed to assess the efficacy of EUS‑PDD. The development of dedicated devices and standardization of EUS-PDD procedures are also necessary.