English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

transgastric rendezvous procedures have been carried out in patients with obstruc− tive chronic pancreatitis, occasionally in− serting stents into the main pancreatic duct (MPD) to facilitate drainage [1 ± 5]. This is the first known report of duodenal stent placement via transgastric access. A 62−year−old male with portal hyperten− sion, presented with symptomatic alco− hol−induced chronic calcific pancreatitis and MPD stones. Drainage could not be achieved during two prior endoscopic retrograde cholangiopancreatographies (ERCPs) due to severe MPD stricturing and occluding intraductal stones. Use of multiple guide wires and attempted forced balloon pancreatogram failed to allow access, or even, visualization of the upstream MPD (l" Fig. 1). Linear EUS was then carried out revealing changes compatible with severe calcific chronic pancreatitis. Initially, a 22 G nee− dle was advanced transgastrically into the MPD, which measured 7 mm in diam− eter. A 0.18" guide wire could not be fed through into the duodenum. Therefore, a 19 G needle was transgastrically inserted and a 0.21" guide wire was advanced into the duodenum via the minor papilla (l" Fig. 2 and l" 3). We performed cathe− ter and balloon (4 mm and 6 mm) dilata− tion of the entire tract (l" Fig. 4). Then a 7 Fr 7 cm straight stent was advanced through the echoendoscope and trans− gastrically into the pancreas, and even− tually to the border of the minor papilla and duodenum (l" Fig. 5). We failed to in− itially consider the need to remove the back flange, which we could not advance through the gastric wall. Therefore, the duodenoscope was reinserted and a snare was used to retract the stent further into the duodenum (l" Fig. 6). A second 7 Fr 7 cm straight stent was inserted to fur− ther promote drainage. No complications developed and the patient is now asymp− tomatic 6 weeks following therapy. This report demonstrates the ability to achieve transpapillary stenting via EUS and a transgastric approach. It should also serve as a reminder to remove the back flange to facilitate stent insertion. Drainage of an inaccessible main pancreatic duct via EUS−guided transgastric stenting through the minor papilla

Drainage of an inaccessible main pancreatic duct via EUS-guided transgastric stenting through the minor papilla