Commentary

This e-Video from Hashimoto et al. shows a salvage endoscopic ultrasound (EUS)-guided rendezvous technique for treatment of disconnected pancreatic duct syndrome (DPDS). The incidence of DPDS amongst patients with severe acute necrotizing pancreatitis ranges between 16% and 46.3% and may be increased by endoscopic necrosectomy procedures [1]. Endoscopic management is now a first-line treatment since percutaneous drainage and surgery have greater morbidity, with a high fistula rate. EUS-guided treatment allows transmural drainage of associated pancreatic fluid collections (PFCs) with a 90% success rate, whereas transpapillary drainage of the disrupted duct has a success rate in less than 50% of cases. The usual option is to leave two double-pigtail stents in place in the PFC to definitively drain the upstream pancreatic duct. Hashimoto et al. demonstrate a new EUS-guided rendezvous technique to treat the disrupted pancreatic duct, and as shown in the video, treatment must await for dilatation of the upstream wirsung duct. EUS offers a new potential for managing all the complications of acute necrotizing pancreatitis.

Publication History

Article published online:
29 March 2021

• Reference

• 1 Verma S, Rana SS. Disconnected pancreatic syndrome: updated review on clinical implications and management. Pancreatology. Pancreatology 2000; 20: 1035-1044