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DOI: 10.1055/s-0043-100216
SpyGlass DS-guided conversion of transmural pancreaticogastrostomy drainage to transpapillary drainage by rendezvous via a lumen-apposing metal stent
Corresponding author
Publikationsverlauf
Publikationsdatum:
13. Februar 2017 (online)
Recently, we reported a successful endoscopic ultrasound-guided pancreatic duct (PD) drainage using a lumen-apposing metal stent (LAMS) plus a pigtail stent in a 44-year-old man with chronic pancreatitis and PD stricture [1]. The patient’s course was satisfactory and 5 months later conversion of the transmural drainage to transpapillary drainage was planned.
The mature fistula, derived from the pancreaticogastrostomy using the LAMS, was used as a port to facilitate access of a SpyScope (Boston Scientific, Natick, Massachusetts, USA) through a therapeutic upper scope. First, a “buried stent effect” was found in the stomach ([Fig. 1]). The LAMS was unearthed using grasping forceps. Then the cholangiopancreatoscope was positioned at the inner end of the stent, and a 0.035-inch guidewire was advanced in an antegrade direction towards the papilla ([Fig. 2] and [Fig. 3]). Contrast filling using an endoscopic retrograde cholangiopancreatography cannula revealed a severe PD stricture, and allowed advancement of the guidewire to inside the duodenal lumen ([Fig. 4]). Curiously, no contrast filling of the small-bowel lumen was observed, and the antegrade approach was aborted and changed to a rendezvous method. The scope was exchanged for a duodenoscope, and good positioning of the guidewire in the duodenal lumen was confirmed ([Fig. 5]). This allowed retrograde pancreatic cannulation, and dilation of the stricture in the pancreatic head using a 6-mm biliary balloon. Finally, a double-pigtail plastic stent (7 Fr × 10 cm; Boston Scientific) was inserted into the major papilla and inside the PD, and its inner end was located in the gastric body, through the LAMS ([Fig. 6]; [Video 1]). No adverse events were reported.
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Qualität:
There is a lack of knowledge about the behavior of transmural drainage in long-term follow-up [2], but it is known that transpapillary drainage more closely replicates normal physiology because pancreatic juice drains directly into the duodenum, an alkaline environment, and enterokinase converts trypsinogen into its active form, trypsin, resulting in the activation of pancreatic digestive enzymes [3].
Endoscopy_UCTN_Code_TTT_1AR_2AI
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Competing interests
None
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References
- 1 Gornals JB, Consiglieri C, Vida F. et al. Endoscopic ultrasound-guided pancreaticogastrostomy using a lumen-apposing metal stent plus a double-pigtail plastic stent. Endoscopy 2016; 48: 276-277
- 2 Chapman CG, Waxman I, Siddiqui UD. Endoscopic ultrasound (EUS)-guided pancreatic duct drainage: the basics of when and how to perform EUS-guided pancreatic duct interventions. Clin Endosc 2016; 49: 161-167
- 3 Feldman M, Friedman LS, Sleisenger MH. Gastrointestinal and liver disease. Volume 1. Pathophysiology, diagnosis, management. 10th. edn. Philadelphia: Saunders-Elsevier; 2016
Corresponding author
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References
- 1 Gornals JB, Consiglieri C, Vida F. et al. Endoscopic ultrasound-guided pancreaticogastrostomy using a lumen-apposing metal stent plus a double-pigtail plastic stent. Endoscopy 2016; 48: 276-277
- 2 Chapman CG, Waxman I, Siddiqui UD. Endoscopic ultrasound (EUS)-guided pancreatic duct drainage: the basics of when and how to perform EUS-guided pancreatic duct interventions. Clin Endosc 2016; 49: 161-167
- 3 Feldman M, Friedman LS, Sleisenger MH. Gastrointestinal and liver disease. Volume 1. Pathophysiology, diagnosis, management. 10th. edn. Philadelphia: Saunders-Elsevier; 2016
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