Duct Drainage Research Articles

Effectiveness of endoscopic ultrasound-guided biliary drainage in patients experiencing obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography

Objective: To assess the treatment outcomes of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with obstructive jaundice due to unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of patients with obstructive jaundice who underwent EUS-BD due to ERCP failure at the Gastrointestinal Endoscopy Center of Beijing Friendship Hospital from September 2018 to November 2023, was retrospectively collected and analyzed. We explored the technical success, clinical success, and adverse events associated with EUS-BD. Results: In total, 43 EUS-BD procedures were performed in 39 patients with a technical success rate of 86.0% (37/43). The clinical success rate was 81.1% (30/37). Biliary drainage was not effectively achieved in seven cases, including two fatal cases and five cases of recurrent postoperative biliary obstruction. The incidence of adverse events was 21.6% (8/37), including two cases of postoperative bile leakage peritonitis, two cases of stent displacement, one case of stent dislocation, one case of perforation, and two cases of death. Conclusion: EUS-BD is a relatively safe and effective method for bile duct drainage, serving as a dependable alternative therapeutic option for patients with obstructive jaundice due to unsuccessful ERCP.

A novel fluoroscopic system improves visibility of devices during endoscopic ultrasound-guided pancreatic duct drainage.

A novel fluoroscopic system improves visibility of devices during endoscopic ultrasound-guided pancreatic duct drainage.

Assesment of Pain Management in Chronic Pancreatitis after Lateral Pancreatico Jejunostomy

Background: The main symptom of chronic pancreatitis is pain, which is treated via lateral pancreaticojejunostomy (LPJ) to relieve symptoms. Patients with dilated pancreatic ducts and excruciating pain are treated with it. Slowing the disease's course and providing optimal pain relief can be accomplished through surgical decompression of the duct and ductal drainage. Objective: The aim of this study is to assessment of pain management in chronic pancreatitis after lateral pancreatico jejunostomy. Methods: The cross-sectional observational study was conducted in the department of Surgery, Avicenna hospital limited, Sirajganj, Bangladesh, from October 2022 to September 2023. A total of 90 patients who underwent lateral pancreatico jejunostomy for patients with chronic pancreatitis were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, with a range from 20 to 70 years, maximum 36 (40.0%) of the patients were within the age group of 31 - 40 years and minimum 5 (5.6%) of the patients were in the age 61 - 70 years and most of the patients 56 (62.20%) were male and 34 (37.80%) patients were female. Most of the patients 46 (51.1%) came from middle-income families. The majority of respondents had history of smoking 53 (58.90%) and 37 (41.10%) were nonsmoker. The majority of respondents had no history of alcohol intake 66 (73.30%) and 24 (26.70%) were alcoholic. Among total population 58 (64.40%) had diabetes mellitus and 32 (35.6%) did not had diabetes mellitus. Majority of the respondents had upper abdominal pain (100%) followed in decreasing order by nausea/vomiting 68 (75.6%), history of weight loss 61 (67.80%), fatigue 47 (52.2%), fever 37(41.10%), steatorrhoea 35(38.90%), diarrhoea 29(32.20%) and shortness of breath 21(23.30%). Majority of the ..

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Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan.

Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS). This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events. A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients. EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Training and quality indicators in interventional endoscopic ultrasound.

Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20-30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3-6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12-15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.

Pancreatic duct occlusion after endoscopic ultrasound-guided transmural pancreatic duct drainage: a pitfall and its rescue technique.

Pancreatic duct occlusion after endoscopic ultrasound-guided transmural pancreatic duct drainage: a pitfall and its rescue technique.

Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic bile duct drainage in the management of malignant obstructive jaundice.

Malignant obstructive jaundice (MOJ) is a condition characterized by varying degrees of bile duct stenosis and obstruction, accompanied by the progressive development of malignant tumors, leading to high morbidity and mortality rates. Currently, the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage (PTBD) and endoscopic ultrasound-guided biliary drainage (EUS-BD). While both methods have demonstrated favorable outcomes, additional research needs to be performed to determine their relative efficacy. To compare the therapeutic effectiveness of EUS-BD and PTBD in treating MOJ. This retrospective analysis, conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University (The First People's Hospital of Changzhou), involved 68 patients with MOJ. The patients were divided into two groups on the basis of surgical procedure received: EUS-BD subgroup (n = 33) and PTBD subgroup (n = 35). Variables such as general data, preoperative and postoperative indices, blood routine, liver function indices, myocardial function indices, operative success rate, clinical effectiveness, and complication rate were analyzed and compared between the subgroups. In the EUS-BD subgroup, hospital stay duration, bile drainage volume, effective catheter time, and clinical effectiveness rate were superior to those in the PTBD subgroup, although the differences were not statistically significant (P > 0.05). The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup (P < 0.05). Postoperative blood routine, liver function index, and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup (P < 0.05). Additionally, the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup (P < 0.05). EUS-BD may reduce the number of punctures, improve liver and myocardial functions, alleviate traumatic stress, and decrease complication rates in MOJ treatment.

Thoracic duct drainage patterns in heterotaxy

BackgroundDisordered lymphatic drainage is common in congenital heart diseases (CHD), but thoracic duct (TD) drainage patterns in heterotaxy have not been described in detail. This study sought to describe terminal TD sidedness in heterotaxy and its associations with other anatomic variables. MethodsThis was a retrospective, single-center study of patients with heterotaxy who underwent cardiovascular magnetic resonance imaging at a single center between July 1, 2019 and May 15, 2023. Patients with (1) asplenia (right isomerism), (2) polysplenia (left isomerism) and (3) pulmonary/abdominal situs inversus (PASI) plus CHD were included. Terminal TD sidedness was described as left-sided, right-sided, or bilateral. ResultsOf 115 eligible patients, the terminal TD was visualized in 56 (49 %). The terminal TD was left-sided in 25 patients, right-sided in 29, and bilateral in two. On univariate analysis, terminal TD sidedness was associated with atrial situs (p = 0.006), abdominal situs (p = 0.042), type of heterotaxy (p = 0.036), the presence of pulmonary obstruction (p = 0.041), superior vena cava sidedness (p = 0.005), and arch sidedness (p < 0.001). On multivariable analysis, only superior vena cava and aortic arch sidedness were independently associated with terminal TD sidedness. ConclusionsTerminal TD sidedness is highly variable in patients with heterotaxy. Superior vena cava and arch sidedness are independently associated with terminal TD sidedness. Type of heterotaxy was not independently associated with terminal TD sidedness. This data improves the understanding of anatomic variation in patients with heterotaxy and may be useful for planning for lymphatic interventions.

Preoperative Surgical or Endoscopic Bile Duct Drainage in Pancreatic Cancer.

Patients with pancreatic cancer and obstructive jaundice routinely undergo endoscopic stent placement (ES). It is well known that ES causes bacterial contamination and infectious complications after pancreatic resection. To compare short-term outcomes and survival in patients undergoing pancreatic head resection after preoperative ES vs preoperative surgical drainage (SD) via T-tube insertion. Patients with obstructive jaundice who underwent SD or ES from 2016 to 2022 were identified from a prospective database. Outcome analyses included microbiological bile contamination, overall morbidity and assessment of the overall complication burden using the Comprehensive Complication Index (CCI). Overall survival was investigated by Kaplan‒Meier analysis. A total of 55 patients with SD were identified and matched with 110 ES patients. After the primary intervention, ES patients experienced more complications (ES: 17.3% vs. SD: 3.6%; P=0.013). The overall complication burden after pancreatic resection was higher in ES patients than in SD patients (CCI: 27.2 vs. 19.9; P=0.022). Additionally, bacterial contamination of the bile was more frequent in ES patients compared to SD individuals (94.3% vs. 7.1%; P<0.001) with similar bacteria in 83.3% of postoperative abdominal infections in ES patients. While overall survival did not differ between the two groups, patients with postinterventional complications after ES had an impaired survival compared to those without complications (11.3mo vs. 20.4mo; P=0.03). SD for obstructive jaundice in resectable pancreatic cancer is associated with a lower overall complication burden. Additionally, patients with complications after ES experience worse overall survival. These findings indicate to rethink our standards of treatment of obstructive jaundice in patients with pancreatic cancer.

Endoscopic ultrasound-guided versus surgical pancreatic duct drainage after failed endoscopic retrograde pancreatography: a pilot comparative study.

Endoscopic ultrasound-guided pancreatic duct (PD) drainage (EUS-PDD) is being increasingly performed as an alternative method to surgical drainage to achieve PD decompression after failed endoscopic retrograde pancreatography (ERP). However, no directly study has compared EUS-PDD with surgical PD drainage after failed ERP in patients with chronic pancreatitis. Consecutive patients who underwent EUS-PDD or longitudinal pancreaticojejunostomy after failed ERP were retrospectively identified from our endoscopy and medical information systems. The primary end point was the Izbicki pain score. The secondary end points were pain relief at the end of follow-up, procedure outcomes, adverse events, readmission, and reintervention. A total of 21 patients (11 EUS-PDD, 10 surgical drainages) were analyzed. There were no significant differences in mean Izbicki pain score (EUS-PDD, 13.6 ± 10.1 vs. surgical drainage 10.7 ± 7.9, p = 0.483) or complete/partial pain relief (60%/30% vs. 70%/30%, p = 0.752) at the end of follow-up of the two groups. The rates of overall adverse events (27.3% vs. 30.0%, p = 0.893) and readmission (63.6% vs. 40.0%, p = 0.290) were similar in the two treatment groups, while patients in EUS-PDD group required more reinterventions (45.5% vs. 0%, p = 0.039) compared with patients in the surgery group. EUS-PDD showed comparable pain relief and safety to surgical PD drainage after failed ERP, with a higher rate of reintervention. The selection of EUS-PDD or surgical drainage may be appropriate based on an individualized strategy.

Functional inferior canalicular reconstruction using a monocanalicular probe after tumor resection of the medial third of the lower eyelid

Purpose: To describe a surgical technique for functionally reconstructing a lacrimal drainage duct and to assess its long-term functionality.Methods: This observational review includes six cases involving reconstruction of the inferior canaliculus after surgical resection of lower eyelid carcinoma. Following lesion excision with safety margins, the epithelium of the distal portion of the inferior canaliculus is located and intubated with a monocanalicular probe. Subsequently, the eyelid lamellae are reconstructed without displacing the probe. The Monoka collarette is then sutured using a 10/0 nylon suture. Data collection included anatomic pathology of the lesion and data from ophthalmic examinations at each visit (including epiphora, inferior canalicular irrigation, and fluorescein dye disappearance test (FDDT)), as well as stent extrusion or other complications.Results: No complications were observed during the surgeries. The stents remained in place for an average of 4 months, with no extrusions prior to removal. The mean follow-up period was 4.8 years (SD=2.0), during which no other complications were noted. Only one patient experienced intermittent epiphora, also present in the fellow eye. At the final visit, FDDT was normal in all eyes, and all patients demonstrated patency of the inferior canaliculus upon irrigation.Conclusion: Primary reconstruction of an inferior lacrimal drainage duct following tumor resection can be successfully performed, resulting in favorable functional recovery.

Elimination of bile leakage in liver injuries

Aim. To study the causes and consequences of bile leakage in liver injury and determine the potential ways for its elimination. Materials and methods. The study involved a retrospective analysis of 204 liver injuries of various types. 26 % of cases were detected with isolated abdominal trauma, 74 % – with concomitant abdominal injury. According to the AAST grading scale, 15.7 % of patients got grade II liver injuries, 44.6 % – grade III, 34.3 % – grade IV, and 5.4 % – grade V. Since concomitant injuries predominated, surgical treatment was initially performed in the overwhelming number of cases. 14 % of cases received non-operative management. Results. The incidence of bile leakage amounted to 28.4 % for all liver injuries and reached 54.9 % for III–V grade injuries (AAST). Small bile leakage prevailed, while active leaking was observed in 36.2 %. Damage to peripheral parts of the biliary tract was noted in most cases (68 %). Conservative management of patients with small bile leakage associated with damage to peripheral parts of the biliary tract appeared successful in 48.5 % of cases. Endoscopic biliary drainage of bile ducts proved effective in case of active bile leakage and (or) injuries of the central bile ducts. Conclusion. Endoscopic biliary drainage of bile ducts is considered the most effective for elimination of active biliary leakage in the absence of biliary peritonitis and communication of biliary tract with pleural cavity.

A PhD completed. More insight into the origin and composition of salivary stones

Salivary stones are hardened, stony calcifications that primarily develop in the drainage duct of a salivary gland. They can lead to obstruction of the saliva flow, resulting in swelling and pain. Since the aetiology of salivary stones remains largely unclear, this was further investigated in this PhD study. A case-control review of patient records showed that systemic diseases and lifestyle factors most likely do not play a role in their occurrence. The biochemical composition of salivary stones removed by oral-maxillofacial surgeons was examined, revealing that large salivary stones have a different inorganic composition than small salivary stones. Several salivary proteins were detected in submandibular salivary stones, including lysozyme, s-IgA, and -amylase. Clumping together of these proteins may play a role in the initial formation of salivary stones.

Technical review of endoscopic ultrasound‐guided drainage/anastomosis and trans‐endosonographically created route procedures for the treatment of pancreatic diseases

AbstractEndoscopic ultrasound (EUS)‐guided pancreatic duct drainage includes two procedures: EUS‐guided drainage/anastomosis (EUS‐D/A) and trans‐papillary drainage with EUS‐assisted pancreatic rendezvous. EUS‐guided pancreatogastrostomy is the most common EUS‐D/A procedure and is recommended as a salvage procedure in cases in which endoscopic retrograde cholangiopancreatography fails or is difficult. However, initial EUS‐D/A is performed in patients with surgically altered anatomy at our institution. It is one of the most difficult interventional EUS procedures and has a high incidence of adverse events. The technical difficulties differ according to etiology, and the incidence of adverse events varies between initial EUS‐D/A and subsequent trans‐endosonographically/EUS‐guided created route procedures. Hence, it is important to meticulously prepare a procedure based on the patient's condition and the available devices. The technical difficulties in EUS‐D/A include: (1) determination of the puncture point, (2) selection of a puncture needle and guidewire, (3) guidewire manipulation, and (4) dilation of the puncture route and stenting. Proper technical procedures are important to increase the success rate and reduce the incidence and severity of adverse events. The complexity of EUS‐D/A is also contingent on the severity of pancreatic fibrosis and stricture. In post‐pancreatectomy cases, determination of the puncture site is important for success because of the remnant pancreas. Trans‐endosonographically/EUS‐guided created route procedures following initial EUS‐D/A are also important for achieving the treatment goal. This article focuses on effective strategies for initial EUS‐D/A, based on the etiology and condition of the pancreas. We mainly discuss EUS‐D/A, including its indications, techniques, and success‐enhancing strategies.

Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan.

Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD. This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events. A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients. Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Feasibility and safety of a novel plastic stent designed specifically for endoscopic ultrasound-guided pancreatic duct drainage.

Background and study aims Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is emerging as an effective alternative treatment for obstructive pancreatitis after unsuccessful endoscopic retrograde pancreatography (ERP). However, the high incidence of adverse events associated with EUS-PD (approximately 20%) remains an issue. Recently, we developed a novel plastic stent for EUS-PD, with a radiopaque marker positioned at approximately one-third of the length from the distal end of the stent and side holes positioned exclusively distal to the marker. This study aimed to evaluate the feasibility and safety of using this stent in EUS-PD. Patients and methods We retrospectively reviewed data from 10 patients who underwent EUS-PD with the novel plastic stent at the National Cancer Center Hospital between March 2021 and October 2023. Technical and clinical success, procedure times, adverse events (AEs), recurrent pancreatic duct obstruction (RPO), and time to RPO were assessed. Results Of the 10 patients, five had postoperative benign pancreaticojejunal anastomotic strictures and five had malignant pancreatic duct obstruction. The technical and clinical success rates were both 100% (10/10). An AE (self-limited abdominal pain) occurred in one patient (10.0%). Two patients (20.0%) died of their primary disease during the follow-up period (median, 44 days; range, 25-272 days). The incidence of RPO was 10.0% (1/10), and the 3-month non-RPO rate was 83.3%. Conclusions The novel plastic stent shows potential as a useful and safe tool in EUS-PD.

Intrahepatic bile duct anatomical variation in liver transplant donors and its implication in liver transplantation

BackgroundFor patients with end-stage liver disease, liver transplantation is considered the chief curative option. Radiological imaging has a pivotal role in evaluating both donors and recipients before and after transplantation. So the purpose of our study is to assess anatomical variant of intra-hepatic bile duct variation among liver transplant donors by MRCP and its implication in liver transplantation. Retrospective study was carried out in Mansoura University Hospitals over period from January 2019 till June 2022. Study included 64 liver transplant donors aged from 21 to 46 years old. All subjects underwent MRCP. Analysis of data obtained from images as well as reconstruction was performed to get images of bile ducts with a maximum intensity projection and volume rendering.ResultsOur study included 64 liver transplant donors. Donor mean age was 29.8 ± 2.57 years with range between 20 and 38 years. There were 40 males (62.5%) and 24 females (37.5%). Regarding right posterior hepatic duct drainage based on Huang classification, the type of bile duct variant was classified as follows: The most common variant was type A1 in 50% of the donors followed by type A4 in 20.3% then type A2 and type A3 in 14.1% each. The distance between RPHD insertion and junction between the right and left hepatic ducts (L) owns a surgical importance as it may need modification of surgical technique if L was more than 1 cm. So according to karakas classification, we had to subtype Huang A1 cases into K1 subtype (L > 1 cm) and K2a subtype (L ≤ 1 cm). Our subjects were 20 with K1 subtype (31.25%) and 12 with K2a subtype (18.75%).ConclusionsAssessment of anatomical variation of right hepatic duct in liver transplant donor by non-invasive method as MRCP had a fundamental role to obtain successful surgical outcome and also to reduce hepatobiliary surgical complications.

Postoperative prophylactic antibiotic therapy after pancreaticoduodenectomy in bile duct-stented patients reduces postoperative major complications

BackgroundPancreaticoduodenectomy can entail a high complication rate, especially in patients who underwent preoperative bile duct drainage through bile duct stenting. Pancreaticoduodenectomy bile duct stenting patients frequently receive prophylactic antibiotic therapy in the postoperative period. However, the exact value and the benefit of prophylactic antibiotic therapy in pancreaticoduodenectomy bile duct stenting patients remains under-investigated and thus unclear. MethodWe conducted a retrospective single-center study of pancreaticoduodenectomy bile duct stenting patients between January 2007 and December 2022. Demographic, clinical, laboratory, and pathology data of 370 patients were collected, and intraoperative swab cultures of the bile were obtained from all patients upon transection of the common bile duct. The groups to be investigated were formed on the basis of postoperative antibiotic prophylaxis. Postoperative complications and antibiotic resistance analysis were recorded. ResultsPostoperative antibiotic prophylaxis in stented patients after pancreaticoduodenectomy significantly reduced major complications (odds ratio: 0.547 [95% confidence interval 0.327–0.915]; P = .02) such as reoperation (P = .041) and readmission to the intensive care unit (P = .037). Patients with Enterococcus faecalis (odds ratio: 1.699 [95% confidence interval 0.978–2.950];P = .048), Enterococcus faecium (odds ratio: 1.808 [95% confidence interval 1.001–3.264]; P = .050), or Citrobacter (odds ratio: 2.211 [95% confidence interval 1.087–4.497]; P = .029) in their bile had a higher probability of developing wound infections. Appropriate antibiotic prophylaxis, according to the bile duct microbiome, significantly reduced the risk of wound infection (odds ratio: 2.239 [95% confidence interval 1.167–4.298]; P = .015). ConclusionPostoperative antibiotic prophylaxis in pancreaticoduodenectomy bile duct stenting patients significantly reduced major complications such as intensive care stay and reoperation. Targeted antibiotic treatment according to the biliary microbiome reduced the incidence of wound infections.

EUS-guided pancreatic duct drainage: a single-center observational study

Background and aimsPancreatic duct obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by endoscopic retrograde cholangiopancreatography. However, in some patients, the classic transpapillary approach cannot be performed because of anatomical inability to access the papilla, rupture of the main pancreatic duct, intracanal stones that cannot be crossed or tight stenosis of the main pancreatic duct due to extrinsic compression by parenchymal calcifications. Endoscopic ultrasound-guided pancreatic duct drainage is an efficient and minimally invasive therapeutic alternative for these patients. We aimed to evaluate clinical success of endoscopic ultrasound-guided pancreatic duct drainage in our center. MethodsData of patients who underwent endoscopic ultrasound-guided pancreatic duct drainage in our center between 2016 and 2022 were retrospectively reviewed. Clinical success was defined as pain ≤2 on the pain Visual Analog Scale (VAS, 0-10) and no recurrence of obstructive pancreatitis after successful stent placement. If the indication to the procedure was chronic pancreatitis with painless weight loss, then clinical success was defined as weight stabilization or weight regain after the procedure. Results46 patients (mean age 58 years old, 69.6% male) were included. Indications of endoscopic ultrasound-guided pancreatic duct drainage were chronic pancreatitis in 69.6% of patients (78.1% due to alcohol abuse). Other indications included post-operative complications, rupture of pancreatic duct and pancreatic cancer. Technical success was achieved in 93.5% of patients. 40 patients had pancreaticogastrostomy and 3 patients pancreaticoduodenostomy. The mean hospital stay was 2 days. Clinical success was 93% in patients who achieved technical success. Remaining pain on the VAS > 2 occurred in 9.3% of patients and obstructive pancreatitis recurrence in 6.9%. Adverse event occurred in 5 patients (11.6%). 18 stent dysfunctions were observed, 16 stent migrations and 2 stent obstructions. No patient died from the procedure. ConclusionEndoscopic ultrasound-guided pancreatic duct drainage showed a high clinical success rate. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with symptomatic pancreatic duct stenosis of benign or malignant etiology who failed endoscopic retrograde cholangiopancreatography.