Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome

Background and study aims: Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) has been reported as an alternative to surgery, when transpapillary access to the main pancreatic duct (MPD) is impossible. The aim of the study was to investigate the feasibility of the procedure and long-term clinical outcome in patients treated with EUS-PD. Patients and methods: We retrospectively analyzed our single-center experience over a 10-year period. Results: EUS-PD was attempted in 20 patients (24 interventions), with a median age of 64 years (range 36-78). Indications for the procedure were post-Whipple symptomatic anastomotic stricture (n = 10) and chronic pancreatitis (n = 10). EUS-PD was performed by a transgastric (n = 16) or transbulbar (n = 3) route or with a rendezvous technique (n = 5). Wirsungography was performed in all interventions and successful drainage was achieved in 18/20 (90%) patients. There were two minor procedure-related complications: bleeding that was treated endoscopically, and a perigastric collection that resolved spontaneously. Median follow up was 37 months (range 3-120 months), stent dysfunction occurred in 9/18 (50%) patients. Out of 18 patients with successful EUS-PD, long-term pain resolution was observed in 13 (72%). At the last follow-up visit, there were significant decreases in pain scores, from 7.5 to 1.6, and in MPD size from 8.1 mm to 3.9 mm. Failure was associated with cancer presence or recurrence. Conclusions: Technical success rate of EUS-PD and clinical long-term pain resolution were 90% and 72%, respectively. EUS-PD is a reliable procedure with a low complication rate. It might therefore replace surgery at expert centers.