Endoscopy 2019; 51(04): S225
DOI: 10.1055/s-0039-1681843
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Endoscopic ultrasound ePosters
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED BILIARY AND PANCREATIC DRAINAGE AS RESCUE DEFINITIVE THERAPY IN A PATIENT WITH CHRONIC PANCREATITIS AND VITAL RISK COMPLICATIONS

JJ Vila
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
L Aburruza
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
G González
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
J Carvalho
2   Hospital Lisboa Norte, Gastroenterology Dpt., Lisboa, Portugal
,
J Costa
3   Hospital de Braga, Gastroenterology Dpt., Braga, Portugal
,
L Uribarri
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
F Estremera
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
J Carrascosa
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
,
I Fernández-Urién
1   Complejo Hospitalario de Navarra, Endoscopy Unit. Gastroenterology Dpt., Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Case:

A 67 year old male patient with records of chronic pancreatitis and partial gastrectomy with Roux-en-Y anastomosis is admitted to the hospital for acute cholangitis. During admission he suffers a bout of acute pancreatitis with infected perirenal collection developing severe sepsis with multiorgan failure requiring soportive therapy and admission to ICU. Pancreatobiliary surgeons decline surgical treatment because of the unacceptable surgical risk. EUS-guided hepaticogastrostomy for treatment of cholangitis and percutaneous drainage of the perirrenal collection are decided with subsequent clinical improvement. Maintained percutaneous purulent drainage precludes from complete resolution of the collection and feeding pancreatic duct dysruption is suspected on a CT scan. As rescue therapy to solve the pancreatic duct dysruption an EUS-guided wirsung-jejunostomy is performed. After this procedure the pancreatic dysruption and perirenal collection are finally resolved and the patient is discharged assymptomatic. One month after discharge he is admitted because of a new bout of acute cholangitis. Antegrade cleansing of the biliary tract with extraction of stones and sludge is performed through the hepaticogastrostomy stent. A prepapillary biliary stenosis is seen and a plastic stent is antegradely and transpapillary placed for treatment of the stenosis. The patient remains assymptomatic and an elective antegrade endoscopic revision is made, both through the wirsung-jejunostomy with transpapillary passage of a new stent to complete the treatment of the pancreatic stenosis, and through the hepaticogastrostomy with retrograde extraction of the biliary plastic stent and placement of a transpapillary fully covered biliary stent to complete the treatment of the biliary stenosis (Video).

Conclusion:

We describe the case of a patient in such a poor condition precluding surgical therapy who was finally resolved by means of EUS-guided biliary and pancreatic drainage. This antegrade accesses allow now to complete the treatment of the biliary and pancreatic duct stenosis secondary to the chronic pancreatitis.