Endoscopic ultrasonography‐guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions

Background Endoscopic ultrasonography ( EUS )‐guided pancreatic drainage has been advocated as a rescue treatment for management of patients in whom retrograde access to the pancreatic duct ( PD ) is technically unsuccessful. The aim of the present study was to evaluate the feasibility and efficacy of EUS ‐guided drainage for failed endoscopic retrograde cholangiopancreatography. Patients and Methods A total of 17 EUS ‐guided PD drainage ( EUS‐PD ) procedures were carried out in 14 patients (age: mean 64.6 years, range 54–81 years, eight men). Results The rendezvous technique was successful in 11 of 17 procedures (64.7%). Three of five patients with an unsuccessful rendezvous technique successfully underwent EUS‐PD stenting (7‐ F r plastic stent [two cases], 5‐ F r endoscopic nasobiliarydrainage [one case]). In the two remaining patients, puncture and pancreatography were successful; however, antegrade passage of the guidewire failed. Conclusion EUS ‐guided decompression of PD is a feasible and effective treatment for the management of symptomatic high‐pressure PD due to stricture of the PD and/or stenotic pancreatodigestive anastomosis. However, this procedure is technically challenging, has a high rate of complications, and should be done only at tertiary‐care centers.