BACKGROUND: Endoscopic decompression of symptomatic main pancreatic duct (MPD) dilation in Whipple patients is often difficult because of stenosis of the pancreaticojejunal (PJ) anastomosis. OBJECTIVE: To evaluate the feasibility and procedural safety of the pancreatic antegrade needle-knife (PANK) technique, with the goal of restoring antegrade MPD flow, when endoscopic retrograde pancreatography (ERP) and EUS-guided rendezvous fail. SETTING: Tertiary care center. DESIGN: Retrospective series. PATIENTS: Three patients with symptomatic MPD dilation refractory to ERP and EUS-guided rendezvous. INTERVENTIONS: Under EUS guidance, a 19-gauge echo-needle was used to gain access to the dilated MPD and a Jagwire advanced. After failed attempts at antegrade guidewire passage across the PJ stenosis, deep transgastric MPD access was achieved via a Soehendra stent retriever and balloon dilation. Careful antegrade needle-knife of the stenotic site was performed. A long pancreatic stent spanning the jejunum, MPD, and gastric access site was placed. Four to 8 weeks later, this stent was upsized and converted to a PJ stent, which in turn was removed 4 weeks thereafter. MAIN OUTCOME MEASUREMENTS: Technical feasibility and complications. RESULTS: All 3 patients successfully underwent the PANK procedure. Pre- and post-MRCP studies showed the mean MPD diameter decreased 60% from 8.3 mm to 3.6 mm (mean follow-up 8 months). At 24-month follow-up, all 3 patients experienced decreased or resolved pain without further need for MPD intervention. LIMITATIONS: Retrospective study with small numbers. CONCLUSIONS: When ERP and EUS rendezvous fail, the PANK procedure using a staged stent strategy seems to be an effective means of MPD decompression.
BACKGROUND: Endoscopic decompression of symptomatic main pancreatic duct (MPD) dilation in Whipple patients is often difficult because of stenosis of the pancreaticojejunal (PJ) anastomosis. OBJECTIVE: To evaluate the feasibility and procedural safety of the pancreatic antegrade needle-knife (PANK) technique, with the goal of restoring antegrade MPD flow, when endoscopic retrograde pancreatography (ERP) and EUS-guided rendezvous fail. SETTING: Tertiary care center. DESIGN: Retrospective series. PATIENTS: Three patients with symptomatic MPD dilation refractory to ERP and EUS-guided rendezvous. INTERVENTIONS: Under EUS guidance, a 19-gauge echo-needle was used to gain access to the dilated MPD and a Jagwire advanced. After failed attempts at antegrade guidewire passage across the PJ stenosis, deep transgastric MPD access was achieved via a Soehendra stent retriever and balloon dilation. Careful antegrade needle-knife of the stenotic site was performed. A long pancreatic stent spanning the jejunum, MPD, and gastric access site was placed. Four to 8 weeks later, this stent was upsized and converted to a PJ stent, which in turn was removed 4 weeks thereafter. MAIN OUTCOME MEASUREMENTS: Technical feasibility and complications. RESULTS: All 3 patients successfully underwent the PANK procedure. Pre- and post-MRCP studies showed the mean MPD diameter decreased 60% from 8.3 mm to 3.6 mm (mean follow-up 8 months). At 24-month follow-up, all 3 patients experienced decreased or resolved pain without further need for MPD intervention. LIMITATIONS: Retrospective study with small numbers. CONCLUSIONS: When ERP and EUS rendezvous fail, the PANK procedure using a staged stent strategy seems to be an effective means of MPD decompression.
Authors: Alban Zarzavadjian Le Bian; Manuela Cesaretti; Nicolas Tabchouri; Philippe Wind; David Fuks Journal: J Gastrointest Surg Date: 2018-07-06 Impact factor: 3.452
Authors: Rachel E Simpson; Eugene P Ceppa; Howard H Wu; Fatih Akisik; Michael G House; Nicholas J Zyromski; Attila Nakeeb; Mohammad A Al-Haddad; John M DeWitt; Stuart Sherman; C Max Schmidt Journal: J Gastrointest Surg Date: 2019-01-02 Impact factor: 3.452
Authors: Aaron Martin; Charles Andrew Kistler; Piotr Wrobel; Juliana F Yang; Ali A Siddiqui Journal: Endosc Ultrasound Date: 2016 May-Jun Impact factor: 5.628