Endoscopic endgame for obstructive pancreatopathy: outcomes of anterograde EUS-guided pancreatic duct drainage. A dual-center study.

Autor: Krafft MR; Section of Gastroenterology and Hepatology, West Virginia University Medicine, Morgantown, West Virginia, USA., Croglio MP; Division of Gastroenterology and Hepatology, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., James TW; Division of Gastroenterology and Hepatology, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Baron TH; Division of Gastroenterology and Hepatology, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Nasr JY; Section of Gastroenterology and Hepatology, West Virginia University Medicine, Morgantown, West Virginia, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2020 Nov; Vol. 92 (5), pp. 1055-1066. Date of Electronic Publication: 2020 May 04.
DOI: 10.1016/j.gie.2020.04.061
Abstrakt: Background and Aims: Anterograde endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) refers to transmural drainage of the main pancreatic duct via an endoprosthesis passed anterograde through the gastric (or intestinal) wall. Anterograde EUS-PDD is a rescue procedure for recalcitrant cases of benign obstructive pancreatopathy.
Methods: We conducted a dual-center retrospective chart review of 28 patients (mean age, 59 years; 50% female) who underwent attempted anterograde EUS-PDD between April 2016 and September 2019 for chronic pancreatitis (CP) (93%) or pancreaticojejunostomy stenosis (PJS) after Whipple resection (7%). The study endpoint was achievement of transpapillary/transanastomotic drainage (definitive therapy).
Results: Gastropancreaticoenterostomy (ring drainage, definitive therapy) was successfully performed during the index procedure in the 2 patients with PJS (technical success, 100%). Clinical success was 100% in the 2 ring drainage recipients during a mean 18-month follow-up period. The remaining 26 patients with CP underwent attempted pancreaticogastrostomy (PG) with 81% technical success, 75% clinical success, and 15% adverse events (AEs). Repeat endoscopic transmural interventions were performed in the 15 patients with clinical success after PG creation. Definitive therapy transpired in all 15 patients after a median 1 repeat procedure per patient. Clinical success after definitive therapy was maintained in all 15 patients (100%) during a median 4.5-month follow-up.
Conclusions: In agreement with previous studies, our study showed mild to moderately high rates of technical failure (19%), clinical failure (25%), and AEs (15%) during index drainage (PG creation). Among patients with CP with both technical and clinical success after index PG creation (n = 15), 100% definitive therapy was achieved and clinical outcomes were excellent (100% clinical success, 0% AEs).
(Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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