Endoscopic laser lithotripsy for a pancreaticojejunostomy stricture using a novel ultra-slim cholangiopancreatoscope via an endoscopic ultrasound-guided pancreatogastrostomy route

Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PD) is now attempted for failed endoscopic retrograde cholangiopancreatography (ERCP). After EUS-PD, antegrade procedures such as stone extraction and laser ablation can be tried. However, during antegrade procedures, a pancreatoscope must be inserted into the main pancreatic duct through an EUS-PD route. To insert the pancreatoscope, tract dilation techniques such as balloon dilation and metal stent deployment have been reported [1] [2]. In cases of balloon dilation, however, the tract might rupture, and the cost of deploying a metal stent is high. To overcome this, an ultra-slim cholangiopancreatoscope with the unique characteristic of providing the working channel exit at the 3 o’clock position (7.8 Fr, Briview, SeeGen Co., Ltd, Shanghai, China) has become available. Technical tips for antegrade laser ablation of a pancreaticojejunostomy stricture (PJS) using this scope are described.

A 71-year-old man underwent pancreaticoduodenostomy due to pancreatic cancer 1 year earlier. He developed frequent pancreatitis due to a PJS and was therefore admitted to our hospital. First, he underwent EUS-PD using a 7-Fr plastic stent without any adverse events. Two weeks later, antegrade treatment was attempted for the PJS. First, a 0.025-inch guidewire was deployed along the plastic stent ([Fig. 1]), and the stent was removed. Then, novel pancreatoscope insertion was attempted without tract dilation, and it was successfully inserted into the main pancreatic duct ([Fig. 2]). The PJS was then identified. Because the probe was extracted from the 3 o’clock position, laser ablation for the PJS could be easily performed without mucosal injury ([Fig. 3]). After antegrade laser ablation, stricture resolution was obtained ([Fig. 4]). Finally, a plastic stent was deployed without any adverse events ([Fig. 5], [Video 1]). This patient underwent stent removal after 3 months, with no stricture recurrence observed during the clinical follow-up.

Fig. 1 A 0.025-inch guidewire is deployed along the plastic stent.

Fig. 2 Novel pancreatoscope insertion is attempted without tract dilation, and it is successfully inserted into the main pancreatic duct.

Fig. 3 Laser ablation for the pancreaticojejunostomy stricture can be easily performed without mucosal injury.

Fig. 4 After antegrade laser ablation, stricture resolution is obtained.

Fig. 5 A plastic stent is deployed without any adverse events.

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Novel pancreatoscope insertion is attempted without tract dilation, and it is successfully inserted into the main pancreatic duct.Video 1

In conclusion, an antegrade procedure using this slim pancreatoscope may be useful because tract dilation is not needed.

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Contributorsʼ Statement

Kimi Bessho: Writing – original draft. Takeshi Ogura: Supervision. Junichi Nakamura: Data curation. Nga Nguyen Trong: Data curation. Hiroki Nishikawa: Project administration.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Ogura T, Ohama H, Higuchi K. Endoscopic Ultrasound-Guided Pancreatic Transmural Stenting and Transmural Intervention. Clin Endosc 2020; 53: 429-435
• 2 Samanta J, Chatterjee A, Dhar J. et al. Endoscopic ultrasound-guided pancreatic duct drainage: a comprehensive state of the art review. Expert Rev Gastroenterol Hepatol 2024; 18: 351-365

Publication History

Article published online:
22 January 2026