Safety and efficacy of EUS-guided pancreatic duct drainage in symptomatic main pancreatic duct obstruction: Is there still a place for surgery?

Abstract

Background and study aims In patients with symptomatic dilation of the main pancreatic duct (MPD) for whom endoscopic retrograde cholangiopancreatography (ERCP) is impossible, surgery has long been the only available treatment. EUS-PD is described as a minimally invasive alternative for ductal decompression surgery. We describe the results of our experience with it.

Patients and methods This was a retrospective single-center study over 9 years. Twenty-seven patients, median age 61.8 years (range 36 to 85) who underwent EUS-PD for symptomatic MPD dilatation were included. The main objective was to evaluate the technical success (placement of a plastic stent between the stomach and the MPD). Secondary objectives were to document clinical success based on pain and quality of life (visual analogic scales and treatments) and complication rates, and to define a standardized management algorithm.

Results The technical success rate was 92.5 %. The rate of minor adverse events was 21 % (4 cases of non-specific postoperative pain and two cases of delayed benign edematous pancreatitis). The clinical success rate was 88 %, and half of patients in whom the procedure was successful had "complete regression" of pain and half "partial regression." Median follow-up was 34.2 months (range 4 to 108). During follow-up, 74 % of patients reported improvement in quality of life and no patients required secondary surgery.

Conclusion Provided it is performed in an expert center, EUS-PD is a minimally invasive, effective, and safe alternative to pancreatic surgical drainage in patients with symptomatic MPD dilatation with failure or in whom ERCP is impossible.

Publikationsverlauf

Eingereicht: 24. April 2020

Angenommen: 07. Oktober 2020

Artikel online veröffentlicht:
27. Mai 2021

• References

• 1 Lévy P, Domínguez-Muñoz E, Imrie C. et al. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United Eur Gastroenterol J 2014; 2: 345-354
• 2 Mullady DK, Yadav D, Amann ST. et al. Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis: a prospective cohort study. Gut 2011; 60: 77-84
• 3 Ebbehøj N, Borly L, Bülow J. et al. Pancreatic tissue fluid pressure in chronic pancreatitis relation to pain, morphology, and function. Scand J Gastroenterol 1990; 25: 1046-1051
• 4 Olesen SS, Bouwense SAW, Wilder-Smith OHG. et al. Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial. Gastroenterology 2011; 141: 536-543
• 5 Wilder-Smith CH, Hill L, Osler W. et al. Effect of tramadol and morphine on pain and gastrointestinal motor function in patients with chronic pancreatitis. Dig Dis Sci 1999; 44: 1107-1116
• 6 Cremer M, Devière J, Delhaye M. et al. Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients. Endoscopy 1991; 23: 171-176
• 7 Cremer M, Deviere J, Delhaye M. et al. Non-surgical management of severe chronic pancreatitis. Scand J Gastroenterol Suppl 1990; 175: 77-84
• 8 Dumonceau J-M, Deviere J, Moine OL. et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc 1996; 43: 547-555
• 9 Brauer BC, Chen YK, Fukami N. et al. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc 2009; 70: 471-479
• 10 Widmer J, Sharaiha RZ, Kahaleh M. Endoscopic ultrasonography-guided drainage of the pancreatic duct. Gastrointest Endosc Clin N Am 2013; 23: 847-861
• 11 Tessier G, Bories E, Arvanitakis M. et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 2007; 65: 233-241
• 12 François E, Kahaleh M, Giovannini M. et al. EUS-guided pancreaticogastrostomy. Gastrointest Endosc 2002; 56: 128-133
• 13 Fink AS, de Ayala VP, Chapman M. et al. Radiologic pitfalls in endoscopic retrograde pancreatography: pancreas. 1986; 1: 180-187
• 14 Cahen DL, Rauws EAJ, Busch OR. et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356: 676-684
• 15 Lucas CE, McIntosh B, Paley D. et al. Surgical decompression of ductal obstruction in patients with chronic pancreatitis. Surgery 1999; 126: 790-795
• 16 Adams DB, Ford MC, Anderson MC. Outcome after lateral pancreaticojejunostomy for chronic pancreatitis. Ann Surg 1994; 219: 481-489
• 17 Nealon WH, Thompson JC. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression a longitudinal prospective analysis of the modified Puestow procedure. Ann Surg 1993; 217: 458-468
• 18 Markowitz JS, Rattner DW, Warshaw AL. Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis. Strategies for salvage. Arch Surg 1994; 129: 374-379 ; discussion 379–380
• 19 Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K. et al. Long-term Anastomotic Complications After Pancreaticoduodenectomy for Benign Diseases. J Gastrointest Surg 2007; 11: 1704-1711
• 20 Amano H, Takada T, Ammori BJ. et al. Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study. Hepatogastroenterology 1998; 45: 2382-2387
• 21 Bories E, Pesenti C, Caillol F. et al. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy 2007; 39: 287-291
• 22 Park DH, Jeong SU, Lee BU. et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc 2013; 78: 91-101
• 23 Barkay O, Sherman S, McHenry L. et al. Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. Gastrointest Endosc 2010; 71: 1166-1173
• 24 Fujii LL, Topazian MD, Abu Dayyeh BK. et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc 2013; 78: 854-864.e1
• 25 Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc 2004; 59: 100-107
• 26 Will U, Fueldner F, Thieme A-K. et al. Transgastric pancreatography and EUS-guided drainage of the pancreatic duct. J Hepatobiliary Pancreat Surg 2007; 14: 377-382
• 27 Kahaleh M, Hernandez AJ, Tokar J. et al. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 2007; 65: 224-230
• 28 Tyberg A, Sharaiha RZ, Kedia P. et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc 2017; 85: 164-169
• 29 Dumonceau J-M, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018. Endoscopy 2019; 51: 179-193
• 30 Jiang L, Ning D, Cheng Q. et al. Endoscopic versus surgical drainage treatment of calcific chronic pancreatitis. Int J Surg 2018; 54: 242-247
• 31 Rösch T, Daniel S, Scholz M. et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy 2002; 34: 765-771
• 32 Delhaye M, Arvanitakis M, Verset G. et al. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol 2004; 2: 1096-1106
• 33 Ponchon T, Bory RM, Hedelius F. et al. Endoscopic stenting for pain relief in chronic pancreatitis: Results of a standardized protocol. Gastrointest Endosc 1995; 42: 452-456
• 34 Fujii-Lau LL, Levy MJ. Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Pancreat Sci 2015; 22: 51-57
• 35 Chen YI, Levy MJ, Moreels TG. et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc 2017; 85: 170-177
• 36 Hayat U, Freeman ML, Trikudanathan G. et al. Endoscopic ultrasound-guided pancreatic duct intervention and pancreaticogastrostomy using a novel cross-platform technique with small-caliber devices. Endosc Int Open 2020; 8: E196-E202
• 37 Costamagna G, Bulajic M, Tringali A. et al. Multiple stenting of refractory pancreatic duct strictures in severe chronic pancreatitis: long-term results. Endoscopy 2006; 38: 254-259
• 38 Oh D, Park DH, Cho MK. et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc 2016; 83: 366-373.e2
• 39 Giovannini M. Endoscopic ultrasound-guided pancreatic duct drainage: Ready for the prime time?. Endosc Ultrasound 2017; 6: 281