A case of successful endoscopic ultrasound/endosonography-guided pancreaticogastrostomy using a novel plastic stent

Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PGS) for calcified chronic pancreatitis is challenging, particularly when it involves insertion of a plastic stent. Therefore, there is a need for an easily insertable dedicated plastic stent [1] [2] [3] [4] [5]. We have developed an integrated plastic stent with an inner catheter and a pull-back mechanism, and to sharpen the plastic stent tip, the inner catheter is inserted only 10 mm beyond the plastic stent tip. The insertion system is novel: the plastic stent is pushed by both the pushing catheter (lower end of the stent) and the inner catheter (near the tip of the stent) ([Fig. 1]). Together with the sharper tip, these features facilitate pushing of the plastic stent. Additionally, the flaps of the new plastic stent are attached to its body to prevent stent migration ([Fig. 2]).

Fig. 1 A newly developed integrated plastic stent. The stent can be pushed from two points: the outer catheter (yellow arrowhead) and the inner catheter (red arrowhead).

Fig. 2 The photograph shows the new plastic stent; the tip is tapered and equipped with large flaps.

We performed EUS-PGS in a 68-year-old man with calcified chronic pancreatitis ([Fig. 3]) in whom an attempt to pass the stricture by the transpapillary route had failed at another hospital. The main pancreatic duct was punctured using a 19-gauge needle, and a 0.025-inch guidewire was inserted past the pancreatic-head stricture. Subsequently, the puncture tract and the stricture were dilated using a 7-Fr drill dilator (Tornus; Olympus Medical Systems, Tokyo, Japan) and a 4-mm balloon catheter (Ren; Kaneka Medical Devices, Tokyo, Japan). While inserting a 7-Fr double-pigtail plastic stent (Piglet, Olympus Medical Systems), the inner catheter passed the stricture, but the stent did not, even after additional balloon dilation. We attempted to pass the stricture using the prototype of the new plastic stent; the attempt was successful. Finally, we placed the tip of the new plastic stent in the duodenum ([Video 1]). EUS-PGS for calcified chronic pancreatitis was hampered by hard parenchyma and the tightness of the stricture. In this case, the new, easy-to-push, anchored plastic stent enabled safe and effective EUS-PGS. More clinical data on the effectiveness of the new plastic stent are needed.

Fig. 3 Magnetic resonance cholangiopancreatography shows strictures and dilatations of the main pancreatic duct; the stricture near the papilla (red arrow) is more severe than the stricture in the body (yellow arrow).

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A case of successful endoscopic ultrasound-guided pancreaticogastrostomy using a novel plastic stent.Video 1

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Conflict of Interest

Author H. I. was supported by research grants from Boston Scientific Japan and FUJIFILM Corporation. These institutions have no role in the design, practice, or analysis of this study. The remaining authors have no conflicts of interest to disclose.

• References

• 1 Dhir V, Isayama H, Itoi T. et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 2017; 29: 472-485
• 2 Nakai Y, Kogure H, Isayama H. et al. Endoscopic ultrasound-guided pancreatic duct drainage. Saudi J Gastroenterol 2019; 25: 210-217
• 3 Imoto A, Ogura T, Higuchi K. Endoscopic Ultrasound-guided pancreatic duct drainage: techniques and literature review of transmural stenting. Clin Endosc 2020; 53: 525-534
• 4 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
• 5 Matsunami Y, Itoi T, Sofuni A. et al. EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series. Endosc Ultrasound 2021; 10: 294-304

Publication History

Article published online:
25 October 2024