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The patient was a 70-year-old male who had undergone pylorus-retaining pancreatic head-duodenectomy and pancreaticogastrostomy for cholangiocarcinoma in 2005. In following period, CT showed that the pancreatic duct become dilated gradually from 5mm in 2008 to 11mm in 2015. From 2011, his diabetic condition got worsen and the pancreatic duct get dilated more than before. Thereafter, in Jan 2015, he was underwent the first esophagogastroduodenoscopy and was found there was a submucosal epithelial lesion in the gastric body. Endoscopic ultrasound (EUS) revealed that the lesion was the significantly dilated pancreatic duct due to obstruction of anastomosis between remaining pancreatic duct and stomach. Because we could not accomplish dilation of the stricture by endoscopic retrograde cholangiopancreatography, we tried an EUS-guided pancreatic duct drainage with rendezvous technique. After trans gastric puncture of the pancreatic duct, the guidewire was inserted into the pancreatic duct, and finally reached to the anastomotic and through the stricture of anastomotic. We grasped the guidewire and a 7Fr pancreatic stent was put in place. After drainage, his pancreatic exocrine function slowly improved. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of stricture of anastomotic after pancreaticogastrostomy with diabetes.

annals of case reports

Pancreatic Duct Drainage Using EUS-Guided Rendezvous Technique for Dilated Pancreatic Duct due to the Stenosis of Anastomotic after Pancreaticogastrostomy: A Case Report