Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Gastrointest Endosc. 2010 Nov;72(5):1081-8. doi: 10.1016/j.gie.2010.07.017.
Endoscopic decompression of symptomatic main pancreatic duct (MPD) dilation in Whipple patients is often difficult because of stenosis of the pancreaticojejunal (PJ) anastomosis.
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.
Tertiary care center.
Retrospective series.
Three patients with symptomatic MPD dilation refractory to ERP and EUS-guided rendezvous.
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.
Technical feasibility and complications.
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.
Retrospective study with small numbers.
When ERP and EUS rendezvous fail, the PANK procedure using a staged stent strategy seems to be an effective means of MPD decompression.
由于胰肠吻合口狭窄，在 Whipple 患者中，对有症状的主胰管（MPD）扩张进行内镜减压往往较为困难。
评估经内镜逆行胰胆管造影术（ERP）和超声内镜引导下会师技术失败时，采用胰腺顺行针刀法（PANK）恢复顺行 MPD 流的可行性和程序安全性。
三级护理中心。
回顾性系列研究。
3 例有症状的 MPD 扩张患者，ERP 和超声内镜引导下会师技术均无效。
在超声内镜引导下，使用 19 号穿刺针进入扩张的 MPD 并插入 Jagwire。在尝试经胰肠吻合口狭窄部位顺行导丝失败后，通过 Soehendra 支架回收器和球囊扩张实现经胃深穿透 MPD 进入。对狭窄部位进行仔细的顺行针刀法。放置一根长的胰管支架，跨越空肠、MPD 和胃进入部位。4 至 8 周后，将该支架扩大并转换为胰肠吻合口支架，4 周后再取出。
技术可行性和并发症。
所有 3 例患者均成功进行了 PANK 手术。术前和术后磁共振胰胆管造影（MRCP）研究显示，MPD 直径平均从 8.3 毫米缩小至 3.6 毫米（平均随访 8 个月）。在 24 个月的随访中，所有 3 例患者疼痛减轻或缓解，无需进一步进行 MPD 干预。
回顾性研究，病例数较少。
当 ERP 和 EUS 会师技术失败时，采用分期支架策略的 PANK 手术似乎是一种有效的 MPD 减压方法。
