EUS-guided transenteric pancreatic duct drainage without cautery for obstructive pancreatitis due to ampullary carcinoma

Abstract

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has been described as an alternative to surgical procedures [1-5]. The patient was a 64-year-old woman with resectable ampullary carcinoma. She was scheduled to undergo pancreatoduodenectomy for the carcinoma; however, obstructive pancreatitis developed. Abdominal computed tomography (CT) revealed dilation of the main pancreatic duct from the tail side of the tumor. Trans-papillary pancreatic duct drainage was attempted; however, the guidewire could not be inserted over the tumor (Figure 1A). Therefore, EUS-PD was performed to resolve pancreatitis before surgery (Video). The patient was sedated with a bolus infusion of 0.05 ml/kg propofol. The main pancreatic duct was not dilated enough to puncture on EUS image from the stomach and trans-duodenal approach was selected for EUS-PD. The dilated main pancreatic duct close to the tumor was punctured with a 19-gauge needle (Expect, Boston) via the duodenal bulb using an echoendoscope (GF-UCT260, Olympus) (Figure 1B, C).

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