PANCREATIC RENDEZVOUS THROUGH LUMEN-APPOSING STENT IN A PATIENT WITH PANCREATICO-PLEURAL FISTULA

Aim:

When the duodenal papilla is endoscopically accessible but impossible to bile duct cannulation, endoscopic ultrasound (EUS) assisted rendezvous is secure and safety. However, regarding the pancreas, if the Wirsung duct is not dilated, USE guided rendezvous is very difficult.

Methods:

49 years-old man diagnosed with chronic pancreatitis was admitted due to dyspnea. Chest and abdominal CT scan was performed and massive right-sided pleural effusion connected with a collection that crosses the diaphragmatic hiatus and communicates with a pseudocyst in pancreas tail of 2 cm was observed. Endoscopic retrograde cholangiopancreatography (ERCP) was performed two times, however Wirsung cannulation was unsuccessful.

Results:

The collection located in the pancreas tail was drained by Hot-Axios lumen-apposing stent (LAMS) 6 × 8 cm by EUS. Contrast was introduced into the collection trough the stent using a fogarty balloon occluding the light of the prosthesis. The contrast passed to the Wirsung and towards the pleura. Two weeks after, new pancreatography through LAMS was performed and 0.025” guidewire passed forward into the Wirsung duct. After that, rendezvous was performed and plastic prosthesis was implanted into the Wirsung, and the Hot Axios was removed. One month later, the plastic prosthesis was removed and the closure of the fistula and the resolution of the pleural effusion was confirmed. After nine months, the fistula has not recurred yet.

Conclusions:

Endoscopic advanced therapeutics is possible using lumen-apposing stents.