Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy

Tetsuya Takikawa, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Eriko Nakano, Shin Miura, Hiroyuki Ariga, Jun Unno, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Hiroshi Yoshida, Yu Katayose, Michiaki Unno, Tooru Shimosegawa

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen- Y hepaticojejunostomy for congenital biliary dilatation at the age of 7. Thereafter, she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy. She developed a pancreatic fistula and an intra-abdominal abscess after the operation. These complications were improved by percutaneous abscess drainage and antibiotic therapy. However, upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy. Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography, we tried an endoscopic ultrasonography (EUS) guided rendezvous technique for pancreatic duct drainage. After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle, the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis. We changed the echoendoscope to an oblique-viewing endoscope, then grasped the guidewire and withdrew it through the scope. The stenosis of the pancreaticojejunostomy was dilated up to 4 mm, and a pancreatic stent was put in place. Though the pancreatic stent was removed after three months, the patient remained symptomfree. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.

Original languageEnglish
Pages (from-to)5182-5186
Number of pages5
JournalWorld Journal of Gastroenterology
Volume19
Issue number31
DOIs
Publication statusPublished - 2013 Aug 31

Keywords

  • Balloon dilatation
  • Endoscopic ultrasoundguided fine needle aspiration
  • Pancreaticobiliary maljunction
  • Pancreaticoduodenectomy
  • Pancreatitis
  • Postoperative complication

ASJC Scopus subject areas

  • Gastroenterology

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