Placement of Pancreatic Plastic Stent via Minor Transpapillary Endoscopic Rendez-Vous

A 34-year-old woman with toxic chronic pancreatitis was admitted due to tense ascites. A diagnostic and therapeutic paracentesis was performed, revealing a biochemical analysis with an amylase level of 42,491 U/L. A computed tomography (CT) scan and magnetic resonance imaging (MRI) were conducted, which showed, in addition to the ascites, calcifying chronic pancreatitis and an irregularly dilated Wirsung duct in the body and tail, with ectasia of the radicles in the head and uncinate process. No disruption of the Wirsung duct was identified.

Following the reappearance of ascites despite therapeutic paracentesis, a endoscopic retrograde cholangiopancreatography (ERCP) was performed, but cannulation of the Wirsung duct from the major papilla was unsuccessful, leading to the decision to perform an endoscopic rendez-vous procedure. Using a linear echoendoscope, a dilated caudal Wirsung duct (3.5 mm) was identified and punctured with a 22G needle. The wirsungography confirmed the dilation in the neck, body, and tail, with disruption at the level of the head. A cystotome was introduced, followed by a 0.025 x 460 cm guidewire that was directed to the duodenum through the minor papilla. The guidewire was retrieved with a duodenoscope, continuing the ERCP. A pancreatic sphincterotomy was performed, presenting significant difficulty in advancing the sphincterotome due to the cephalic disruption of the Wirsung duct, and dilatations were carried out using 4 and 5 Fr balloon catheters. Finally, a 5 Fr x 5 cm plastic pancreatic stent was placed transpapillary.

Post-procedure, the patient exhibited resolution of the ascites, with no recurrence during the subsequent follow-up period of 8 months.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025