Long-term outcome after endoscopic ultrasound-guided pancreatic duct drainage

Obstruction of the main pancreatic duct (MPD) may result in severe pain, recurrent pancreatitis, and pancreatic insufficiency. Endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct cannulation and stent placement is the standard first-line approach, yet it sometimes fails or is not feasible. Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) has emerged as a surgical alternative. We assessed the long-term outcomes, safety, and technical aspects of EUS-PDD.

We retrospectively reviewed all adult patients who underwent EUS-PDD at a tertiary referral center between April 2016 and November 2022. Only patients who underwent pancreatogastrostomy or pancreatojejunostomy and had at least 12 months of follow up were included. Clinical success was defined as a residual visual analog scale score ≤2 without obstructive pancreatitis recurrence. Adverse events, reinterventions, and long-term outcomes were analyzed.

Thirty-five patients (mean age 58±11 years; 74% male) were included, with a mean follow up of 23±19 months. Chronic pancreatitis accounted for 54% of indications. Technical success was achieved in all patients. Overall clinical success was 80% (95% confidence interval [CI] 64-91%). Adverse events occurred in 17% (95%CI 7-33%), including severe events in 6%. Reintervention was required in 29% of patients, mainly because of stent dysfunction. During follow up, 26% experienced pancreatitis, most commonly related to stent dysfunction. Two deaths occurred, unrelated to pancreatic disease or the procedure.

EUS-guided pancreatic duct drainage is a safe and effective long-term treatment option in selected patients with MPD obstruction or disruption when ERCP is not feasible, providing durable symptom control with acceptable morbidity.