EUS-guided Therapy of Pancreatic Duct Stones in Chronic Pancreatitis: Not a Good Alternative Yet!

Abstract

Purpose: Surgery is usually indicated for symptomatic patients who failed ERP therapy of pancreatic duct (PD) stones. EUS-guided pancreatic duct access and drainage (EUS-PDAD) has emerged as a potentially effective diagnostic and therapeutic technique. Clinical experience with EUS-PDAD and data in the literature on the outcomes of this procedure are lacking. Therefore, we report our experience of EUS-PDAD at our tertiary care center. Methods: A retrospective chart review was performed of all patients who underwent EUS-PDAD at our center from 6/07-6/09. Patients were identified by searching endoscopy database and all procedures were performed by a single experienced endoscopist (MRA). Each patient was evaluated for the following parameters and outcomes: Demographic data, indications for ERP and EUS-PDAD, duct access rates, success rates for rendezvous procedure versus trans-mural drainage, interventions performed at time of procedure, complications, and clinical outcomes. The study was approved by the IRB of the University of Missouri. Results: 5 cases of EUS-PDAD were identified with the average age of 57± 15 years. The indication was failed ERP in patients with chronic pancreatitis, dilated PD, and PD stones. Each patient had at least one failed ERP prior to the attempted EUS-PDAD. ERP failure was attributed to inability to cannulate the PD due to strictures, stones, or distorted anatomy. EUS-guided access to the PD was achieved in all 5 cases (100%). Rendezvous procedure was attempted in all patients but was unsuccessful. Subsequently, EUS-pancreaticogastrostomy and stent placement was successful in 1 patient (20%), who had significant clinical and radiological improvement after therapy. Complications related to the procedure were mild pancreatitis in 2 patients, treated conservatively in both occasions with no sequelae. Conclusion: EUS-pancreatic duct access is technically successful. EUS-pancreatic duct drainage is technically successful only in a minority of cases. In our experience, this procedure appears to have little success in patients with severe chronic pancreatitis and PD stones. EUS-PDAD is presently not an attractive option in patients with severe chronic pancreatitis.