DISCONNECTED PANCREATIC DUCT SYNDROME (DPDS): ENDOSCOPIC REPAIR BY MEANS OF STAGED EUS-GUIDED PANCREATICO-GASTROSTOMY (EUS-PG) COMBINED WITH ERCP

Introduction DPDS requires distal pancreatectomy to avoid persistent/recurrent collections/pancreatitis/fistulas. We describe endoscopic reconnection, novel alternative.

Description Relapsing pancreatitis. EUS-pancreatography confirms DPDS with communicating pseudocyst. 3-Stage treatment: drainage, recanalization and remodeling. EUS-PG and transpapillary pseudocyst drainage by ERCP with dual-SEMS (Stage-1). Partial inward migration of PG-SEMS at 1-week requires distal repositioning through another EUS-guided puncture. 2-months later: pseudocyst resolution, SEMS removal, antegrade rendezvous recanalization of DPDS with through-and-through double-pig-tail (Stage-2). 9-months later, transpapillary-transgastric double-pig-tail exchanged for transpapillary intraductal 10F-plastic stent across DPDS pending definitive removal (Stage-3).

Conclusions Patient remains asymptomatic since drainage (19-months). DPDS is reconnected, awaiting final transpapillary stent removal.