Commentary

Bonnichsen et al. present a compelling application of endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), or EDGE, in the therapeutic management of disconnected pancreatic duct syndrome (DPDS) [1]. The complexity of their case is highlighted by the failure of the multiple previous percutaneous and laparoscopic attempts to drain the pancreatic collection. The case underscores the potential of EDGE [2] [3] as a viable alternative to more traditional techniques such as balloon-, spiral enteroscopy-, and laparoscopy-assisted ERCP [4] [5], which are often complicated by suboptimal technical success.

EDGE facilitated multiple procedures, first enabling transpapillary drainage of the collection followed by the successful deployment of a pancreatic stent to bridge and heal the disconnected duct. Notably, the potential for migration of the gastrogastric lumen-apposing metal stent (LAMS), a recognized adverse event associated with EDGE, was effectively mitigated through the use of a larger LAMS, as suggested in the literature [6], and through the application of endoscopic sutures. The concurrent use of the endoscopic suturing system after LAMS deployment increased the technical complexity of the procedure and demonstrated the versatile competences of the team in using different advanced devices.

In conclusion, this case underscores the potential of EDGE as a viable solution for complex clinical scenarios necessitating multiple interventions, and provides valuable insights into the potential benefits and challenges associated with the use of EDGE in the management of DPDS.

Publication History

Article published online:
23 April 2024

• References

• 1 Bonnichsen MH, Chua PBG, Wu CCH. et al. Endoscopic ultrasound-directed transgastric ERCP for disconnected pancreatic duct syndrome: finding the edge to bridge the gap. Endoscopy 2024; 56 (Suppl. 01) E41-E42
• 2 Bahdi F, George R, Paneerselvam K. et al. Comparison of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography outcomes using various technical approaches. Endosc Int Open 2022; 10: E459-467
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