Aims In patients with symptomatic dilation of the main pancreatic duct (CPP) with failure
endoscopic cholangiopancreatography (ERCP) or impossibility to cross a stricture or
a stone with a wire, surgical management has long been the only available treatment.
EUS-drainage is a minimally invasive approach for complicated duct drainage. Wirsungo-gastrostomy
under EUS (EUS-WG) is an alternative to ductal decompression surgery, thus we describe
our experience.
Methods Between 2010 and 2018 twenty-seven consecutive patients aged 61.8 years [36 - 85]
were included and analyzed, in whom EUS-WG was performed for symptomatic main pancreatic
duct (MPD) obstruction with ERCP failure. The procedures were performed in patients
intubated, in supine position with an EUS linear scope. It consisted of puncturing
the MPD through the stomach, then place a wire and a plastic stent. The primary objective
was to evaluate the technical success defined by the placement of the stent into the
MPD. The secondary objectives were to assess clinical success on the pain symptom,
complications, and quality of life through a standardized follow-up questionnaire.
Results The technical success was achieved in 92.5% of the cases. The adverse event rate
was 21%, all classified as non-severe, including 4 postoperative pain and 2 acute
benign pancreatitis medically managed. The clinical success rate was 88%, of which
half presented a ‘complete regression’ and the other half a ‘partial regression’ of
the pain. During a median time of follow-up of 34.2 months [4-108], an improvement
in quality of life was reported in 74% of patients and no patients required secondary
surgery. The stents were exchanged every 6 months.
Conclusions Provided it is performed in an expert center, WG-EUS offers a minimally invasive,
effective and safe alternative to surgical pancreatic decompression in patients with
symptomatic dilation of CPP with failure or impossibility of ERCP.
