Therapeutic endoscopy for stenotic pancreatodigestive tract XXXX after pancreatoduodenectomy (with videos).

@entity1 @entity788 @entity254 @entity292 @entity850
BACKGROUND: Pancreatodigestive tract anastomotic site @entity850 is a problematic complication after pancreatoduodenectomy. OBJECTIVE: We evaluated the feasibility and efficacy of endoscopic treatments for a stenotic pancreatodigestive tract @entity254 . DESIGN: Retrospective study. SETTING: Endoscopic units of a university-affiliated hospital and a general hospital. @entity1 : Fourteen @entity1 with recurrent @entity788 (n=10) and pancreatic fluid @entity292 (n=4) after anatomy-altering surgery with pancreatodigestive tract @entity254 . INTERVENTIONS: The initial ERCP included obtaining a pancreatogram, introducing a 0.025-inch guidewire through the @entity254 , along which a 5F plastic stent or nasopancreatic drain was inserted. If initial ERCP failed, we attempted EUS-guided rendezvous, with a guidewire passed antegrade from the main pancreatic duct across the stenotic @entity254 . MAIN OUTCOME MEASUREMENTS: Rates of successful intervention and clinical relief. RESULTS: The initial intervention was successfully achieved in 6 of 14 @entity1 (38%). Of the 6 @entity1 with successful therapeutic endoscopies, 4 (66.7%) and 2 (25.0%) had undergone a previous pancreatogastrostomy or pancreatojejunostomy, respectively. Eight @entity1 with an initial unsuccessful intervention successfully underwent a second intervention using an EUS-guided or US-guided rendezvous method. Finally, @entity850 was relieved in all @entity1 with either the retrograde placement of a pancreatic duct stent across the @entity850 of an anastomotic site or antegrade percutaneous bougienage of the stenotic @entity254 . LIMITATIONS: Small sample size and lack of control @entity1 . CONCLUSIONS: Endoscopic treatment of stenotic pancreatodigestive tract @entity254 for transanastomotic pancreatic juice drainage is safe and feasible.
