EUS-guided pancreaticogastrostomy

Background: The pain of chronic pancreatitis can be caused by pancreatic ductal hypertension, and endoscopic drainage of the main pancreatic duct can provide relief. When transpapillary access to a dilated portion of the main duct cannot be obtained, conventional endoscopic drainage is not possible. The use of interventional EUS to perform a pancreaticogastrostomy in such cases is described. Methods: Four patients presented with pain and a dilated main pancreatic duct proximal to a complete obstruction. EUS was used to access the dilated duct and create a pancreaticogastrostomy. Patency of the latter was maintained by placement of a pancreaticogastric stent. Observations: EUS-guided pancreaticogastrostomy was performed without major complication. Three of 4 patients had satisfactory relief of pain at a median follow-up of 1 year. Conclusion: EUS-guided pancreaticogastrostomy may be a promising new technique for pancreatic drainage and pain relief when conventional transpapillary access to the pancreatic duct is not possible.