An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery

Yen I. Chen, Michael J. Levy, Tom G. Moreels, Gulara Hajijeva, Uwe Will, Everson L. Artifon, Kazuo Hara, Masayuki Kitano, Mark Topazian, Barham K Abu Dayyeh, Andreas Reichel, Tiago Vilela, Saowanee Ngamruengphong, Yamile Haito-Chavez, Majidah Bukhari, Patrick Okolo, Vivek Kumbhari, Amr Ismail, Mouen A. Khashab

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

Background and Aims Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy. Methods This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included. Results In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P <. 001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P <. 001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P <. 001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups. Conclusions EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available.

Original languageEnglish (US)
Pages (from-to)170-177
Number of pages8
JournalGastrointestinal endoscopy
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2017

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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