Antegrade pancreatoscopy via EUS-guided pancreaticogastrostomy allows removal of obstructive pancreatic duct stones

Abstract

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment for pancreaticolithiasis, including use of pancreatoscopy for intraductal electrohydraulic lithotripsy (IEHL). Pancreatoscopy is often limited by a small-caliber downstream pancreatic duct as well as an unstable pancreatoscope position within the pancreatic head. Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PG) has been developed as a method to relieve ductal obstruction when retrograde access fails. The current study describes pancreatoscopy via EUS-PG, a novel method for managing obstructing pancreaticolithiasis. Patients and methods From September 2017 to January 2018, patients who underwent EUS-PG followed by antegrade pancreatoscopy via PG were identified. Endoscopy reports, medical charts and relevant laboratory data were reviewed and recorded. Results Five patients underwent EUS-PG and antegrade pancreatoscopy via PG during the study period; clinical success rate was 100 %. There were no significant adverse events during the procedure or follow up period. Conclusions Pancreatoscopy via PG for IEHL is safe and effective for treating obstructing pancreaticolithiasis in patients who have previously failed ERCP or in clinical scenarios were ERCP is not possible.