EUS-guided pancreatic duct intervention: Outcomes of a single tertiary-care referral center experience

Larissa L. Fujii, Mark D. Topazian, Barham K. Abu Dayyeh, Todd H. Baron, Suresh T. Chari, Michael B. Farnell, Ferga C. Gleeson, Christopher J. Gostout, Michael L. Kendrick, Randall K. Pearson, Bret T. Petersen, Mark J. Truty, Santhi S. Vege, Michael J. Levy

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background: EUS can provide access to the main pancreatic duct (MPD) for therapeutic intervention. The long-term clinical success of EUS-guided MPD interventions is unknown. Objective: To determine technical and clinical success rates, predictors of success, and long-term outcomes of EUS-guided MPD intervention. Design: Retrospective, single-center study. Setting: Tertiary-care referral center. Patients: Forty-five patients. Intervention: EUS-guided MPD stent retrieval or placement. Main Outcome Measurements: Technical and clinical success rates, adverse events, and long-term clinical outcomes. Results: Among the 45 patients, 37 had undergone failed ERCP, and 29 had surgically altered anatomy. Median follow-up after initial EUS-guided intervention was 23 months. Two patients underwent EUS for stent removal, and EUS-guided MPD stent placement was attempted in 43 patients. Technical success was achieved in 32 of 43 patients (74%) with antegrade (n = 18) or retrograde (n = 14) stent insertion. Serious adverse events occurred in 3 patients (6%). Patients underwent a median of 2 (range 1-6) follow-up procedures for revision or removal of stents, without adverse events. Complete symptom resolution occurred in 24 of 29 patients (83%) while stents were in place, including all 6 with nondilated ducts. Stents were removed in 23 patients, who were then followed for an additional median of 32 months; 4 patients had recurrent symptoms. Among the 11 failed cases, most had persistent symptoms or required surgery. Limitations: Retrospective study design, individualized patient management. Conclusion: EUS-guided MPD intervention is feasible and safe, with long-term clinical success in the majority of patients. EUS provides important treatment options, particularly in patients who would otherwise undergo surgery.

Original languageEnglish (US)
Pages (from-to)854-864.e1
JournalGastrointestinal endoscopy
Volume78
Issue number6
DOIs
StatePublished - Dec 2013

Keywords

  • ERP
  • MPD
  • endoscopic retrograde pancreatography
  • main pancreatic duct

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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