WIRSUNGO-GASTRIC ANASTOMOSIS UNDER ENDOSCOPIC ULTRASOUND (EUS) IN THE MANAGEMENT OF SYMPTOMATIC DILATION OF THE MAIN PANCREATIC DUCT: A TERTIARY CENTER EXPERIENCE

Aims In patients with symptomatic dilation of the main pancreatic duct (CPP) with failure endoscopic cholangiopancreatography (ERCP) or impossibility to cross a stricture or a stone with a wire, surgical management has long been the only available treatment. EUS-drainage is a minimally invasive approach for complicated duct drainage. Wirsungo-gastrostomy under EUS (EUS-WG) is an alternative to ductal decompression surgery, thus we describe our experience.

Methods Between 2010 and 2018 twenty-seven consecutive patients aged 61.8 years [36 - 85] were included and analyzed, in whom EUS-WG was performed for symptomatic main pancreatic duct (MPD) obstruction with ERCP failure. The procedures were performed in patients intubated, in supine position with an EUS linear scope. It consisted of puncturing the MPD through the stomach, then place a wire and a plastic stent. The primary objective was to evaluate the technical success defined by the placement of the stent into the MPD. The secondary objectives were to assess clinical success on the pain symptom, complications, and quality of life through a standardized follow-up questionnaire.

Results The technical success was achieved in 92.5% of the cases. The adverse event rate was 21%, all classified as non-severe, including 4 postoperative pain and 2 acute benign pancreatitis medically managed. The clinical success rate was 88%, of which half presented a ‘complete regression’ and the other half a ‘partial regression’ of the pain. During a median time of follow-up of 34.2 months [4-108], an improvement in quality of life was reported in 74% of patients and no patients required secondary surgery. The stents were exchanged every 6 months.

Conclusions Provided it is performed in an expert center, WG-EUS offers a minimally invasive, effective and safe alternative to surgical pancreatic decompression in patients with symptomatic dilation of CPP with failure or impossibility of ERCP.