Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, Belgium; Imelda GI Research Center, Bonheiden, Belgium.
Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Gastroenterology and Hepatology, AZ Damiaan, Oostende, Belgium.
Dig Liver Dis. 2024 Jan;56(1):170-175. doi: 10.1016/j.dld.2023.07.027. Epub 2023 Aug 8.
EUS-guided pancreatic duct drainage (EUS-PD) using rendez-vous has been suggested as a safer alternative to pancreatogastrostomy. Fibrostenotic disease in the pancreatic head may however preclude major papilla rendez-vous, leading to preferential guidewire advancement through the minor papilla. Our aim was to compare the outcomes of minor and major papilla rendez-vous.
This is a tertiary single-center retrospective analysis of all consecutive EUS-PD procedures performed from 2015 to April 2022. EUS-PD was only performed following failed retrograde attempts. Successful EUS-PD rendez-vous cases were included and minor and major papilla procedures were compared.
Thirty-three patients were included in the final analysis (66.6% male, mean age 56.1 [SD±14.8] years, 54.6% active smokers). In 21 patients (63.6%), minor papilla rendez-vous was attained. Clinical success was achieved in 81.0% vs. 58.3% in the major papilla group (p = 0.230). The overall incidence of AE was similar in both groups (9 [42.9%] vs. 4 [33.3%] events, p = 0.719), with a comparable distribution in severe, moderate and mild AE. Incidence of recurrent pancreatitis was almost identical (28.6% vs. 25.0%, p = 1.000).
For patients with symptomatic chronic pancreatitis, EUS-PD using minor or major papilla rendez-vous attained similar results, suggesting that pancreatic duct drainage through the minor papilla can be considered as equally effective.
超声内镜引导下胰腺管引流（EUS-PD）通过 rendez-vous 技术被认为是一种比胰胃吻合术更安全的替代方法。然而，胰头部纤维性狭窄性病变可能会妨碍主要乳头 rendez-vous，导致导丝优先通过小乳头进入。我们的目的是比较小乳头和大乳头 rendez-vous 的结果。
这是一项对 2015 年至 2022 年 4 月期间进行的所有连续 EUS-PD 手术的三级单中心回顾性分析。EUS-PD 仅在逆行尝试失败后进行。包括成功的 EUS-PD rendez-vous 病例，并比较小乳头和大乳头手术。
最终分析包括 33 例患者（66.6%为男性，平均年龄 56.1 [±14.8] 岁，54.6%为主动吸烟者）。在 21 例患者（63.6%）中，达到了小乳头 rendez-vous。主要乳头组的临床成功率为 81.0%，而小乳头组为 58.3%（p=0.230）。两组的总体不良事件发生率相似（9 [42.9%] vs. 4 [33.3%]事件，p=0.719），严重、中度和轻度不良事件的分布相似。复发性胰腺炎的发生率几乎相同（28.6% vs. 25.0%，p=1.000）。
对于有症状的慢性胰腺炎患者，通过小乳头或大乳头 rendez-vous 进行 EUS-PD 可获得相似的结果，这表明通过小乳头进行胰管引流可以同样有效。
