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DOI: 10.1055/s-2007-966150
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic ultrasound-guided pancreaticogastrostomy reconstruction
M. Kitano, MD
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Kinki University School of Medicine
377-2 Ohno-Higashi
Osaka-Sayama 589-8511
Japan
Fax: +81-72-367-2880
eMail: m-kitano@med.kindai.ac.jp
Publikationsverlauf
Publikationsdatum:
13. März 2007 (online)
Severe stenosis and obstruction of a pancreaticogastrostomy anastomosis sometimes occurs after surgical pancreatic resection and pancreaticogastrostomy, resulting in abdominal pain and aggravation of diabetes as a result of ductal hypertension [1]. Endoscopic ultrasound-(EUS-)guided pancreaticogastrostomy has been reported as a method for reducing ductal hypertension in patients with chronic pancreatitis. We report a patient who underwent EUS-guided reconstruction of a pancreaticogastrostomy with gastropancreatic stent placement, which rapidly improved his symptoms [2] [3].
A 65-year-old man who had a branch duct type of intrapapillary mucinous neoplasm (IPMN) ([Figure 1]) underwent a duodenum-preserving pancreatic head resection and pancreaticogastrostomy anastomosis. Forty-five days later, he developed a pancreatic pseudocyst ([Figure 2]), which was drained under EUS guidance. Although computed tomography 6 months later showed that the pseudocyst had disappeared, the scan showed dilatation of the main pancreatic duct ([Figure 3]). Decompression of the pancreatic duct was required to relieve his abdominal pain and reduce his hyperglycemia. Because the main pancreatic duct could not be drained by endoscopic retrograde pancreatography, EUS-guided pancreaticogastrostomy reconstruction was performed. An echo endoscope (GF-UC240 P-AL5; Olympus, Tokyo, Japan) was introduced into the stomach, and a 19-gauge needle (Echo-Tip; Wilson-Cook, Winston-Salem, North Carolina, USA) was used to puncture the main pancreatic duct and create a gastropancreatic fistula. We initially attempted to pass a 0.035-inch guide wire (Microvasive Endoscopy, Boston Scientific Corporation, Natick, Massachusetts, USA) through the stenotic anastomosis, but the guide wire could not be passed through the anastomosis ([Figure 4]). A 6-Fr (Soehendra Biliary Dilation Catheters, Wilson-Cook, Winston-Salem, North Carolina, USA) dilator was advanced over the guide wire to dilate the gastropancreatic fistula, and then a 5-Fr, 5-cm-long pancreatic stent (Geenen Pancreatic Stent Set, Wilson-Cook, Winston-Salem, North Carolina, USA) was advanced over the wire and through the gastropancreatic fistula. The stent was placed in the pancreatic duct with the tip positioned in the proximal duct ([Figure 5], [Figure 6]). The patient’s abdominal pain was rapidly relieved and his hyperglycemia had improved 1 month later.
Endoscopy_UCTN_Code_TTT_1AS_2AD
#References
- 1 Amano H, Takada T, Ammori B J. et al . Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study. Hepatogastroenterology. 1998; 45 2382-2387
- 2 Francois E, Kahalen M, Giovannini M. et al . EUS-guided pancreaticogastrostomy. Gastrointest Endosc. 2002; 56 128-133
- 3 Gress F, Ikenberry S, Sherman S. et al . Endoscopic ultrasound-directed pancreatography. Gastrointest Endosc. 1996; 44 736-739
M. Kitano, MD
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Kinki University School of Medicine
377-2 Ohno-Higashi
Osaka-Sayama 589-8511
Japan
Fax: +81-72-367-2880
eMail: m-kitano@med.kindai.ac.jp
References
- 1 Amano H, Takada T, Ammori B J. et al . Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study. Hepatogastroenterology. 1998; 45 2382-2387
- 2 Francois E, Kahalen M, Giovannini M. et al . EUS-guided pancreaticogastrostomy. Gastrointest Endosc. 2002; 56 128-133
- 3 Gress F, Ikenberry S, Sherman S. et al . Endoscopic ultrasound-directed pancreatography. Gastrointest Endosc. 1996; 44 736-739
M. Kitano, MD
Division of Gastroenterology and Hepatology
Department of Internal Medicine
Kinki University School of Medicine
377-2 Ohno-Higashi
Osaka-Sayama 589-8511
Japan
Fax: +81-72-367-2880
eMail: m-kitano@med.kindai.ac.jp