Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Dig Endosc. 2013 May;25 Suppl 2:109-16. doi: 10.1111/den.12100.
Endoscopic ultrasonography (EUS)-guided pancreatic drainage has been advocated as a rescue treatment for management of patients in whom retrograde access to the pancreatic duct (PD) is technically unsuccessful. The aim of the present study was to evaluate the feasibility and efficacy of EUS-guided drainage for failed endoscopic retrograde cholangiopancreatography.
A total of 17 EUS-guided PD drainage (EUS-PD) procedures were carried out in 14 patients (age: mean 64.6 years, range 54-81 years, eight men).
The rendezvous technique was successful in 11 of 17 procedures (64.7%). Three of five patients with an unsuccessful rendezvous technique successfully underwent EUS-PD stenting (7-Fr plastic stent [two cases], 5-Fr endoscopic nasobiliary drainage [one case]). In the two remaining patients, puncture and pancreatography were successful; however, antegrade passage of the guidewire failed.
EUS-guided decompression of PD is a feasible and effective treatment for the management of symptomatic high-pressure PD due to stricture of the PD and/or stenotic pancreatodigestive anastomosis. However, this procedure is technically challenging, has a high rate of complications, and should be done only at tertiary-care centers.
内镜超声引导下胰腺引流术已被提倡作为治疗逆行胰管（PD）技术不成功的患者的挽救性治疗。本研究旨在评估内镜超声引导下引流术治疗内镜逆行胰胆管造影失败的可行性和疗效。
14 例患者共进行了 17 例内镜超声引导下 PD 引流（EUS-PD）手术（年龄：平均 64.6 岁，范围 54-81 岁，8 名男性）。
17 例手术中， rendezvous 技术成功 11 例（64.7%）。5 例 rendezvous 技术不成功的患者中，有 3 例成功进行了 EUS-PD 支架置入术（7Fr 塑料支架[2 例]，5Fr 内镜鼻胆管引流[1 例]）。在另外 2 例患者中，穿刺和胰管造影成功，但导丝逆行通过失败。
EUS 引导下 PD 减压术是治疗 PD 狭窄和/或狭窄性胰肠吻合口引起的高压 PD 所致症状的可行且有效的治疗方法。然而，该操作技术难度大，并发症发生率高，仅应在三级医疗中心进行。
