EUS antegrade pancreatography with gastropancreatic duct stent placement: review of two cases

Background. Endoscopic retrograde pancreatography is an established procedure for palliation of patients with pain caused by chronic pancreatitis associated with pancreatic ductal stricture. Some patients may not be candidates for endoscopic retrograde pancreatography because of surgically altered anatomy. Two cases are presented in which endoscopic retrograde pancreatography was unsuccessful and EUS-guided antegrade pancreatography with gastropancreatic stent placement was performed. Methods: EUS-guided antegrade pancreatography was performed in both patients by creating a gastropancreatic fistula through which dilation and stent placement were performed over a guidewire. Results: Stent insertion was successful in both cases. Both patients experienced rapid improvement in symptoms. Conclusions: EUS-guided antegrade pancreatography with stent placement may be an alternative to endoscopic retrograde pancreatography when surgical reconstruction precludes access to the major and minor papillae.