4th Year Advanced Endoscopy Fellows Program | October 2021-Glessing

Glessing_Endoscopic Pancreatic Case

Pdf Summary

The document discusses the ASGE and Case Western University 4th Year Advanced Endoscopy Fellows Program, particularly focusing on the topic of Disconnected Pancreatic Duct Syndrome (DPDS). DPDS is a complication of acute necrotizing pancreatitis and chronic pancreatitis (CP) that involves the disconnection between the viable upstream pancreatic parenchyma and the duodenum. This can lead to recurrent pancreatic fluid collections, refractory external pancreatic fistulas, and chronic abdominal pain or recurrent pancreatitis.<br /><br />Currently, surgery is the primary management for patients with DPDS. However, the document explores the use of EUS-guided pancreatic duct (PD) access as a minimally invasive approach to treating DPDS. The document presents three different cases that demonstrate various approaches to EUS-guided PD access for treatment.<br /><br />Case 1 involves a male patient with necrotizing pancreatitis who had previously undergone treatment with double pigtail stents. A retrograde approach using a temporary pancreaticogastric stent is used for PD rendezvous (RDV) access.<br /><br />Case 2 involves a female patient with a history of necrotizing pancreatitis who had undergone cystgastrostomy with double pigtail stents. EUS guided PD access and reconnection through the "classic rendezvous" technique are successfully used for treatment.<br /><br />Case 3 involves a male patient with a history of pancreas divisum and chronic pancreatitis. He had undergone previous treatments such as EUS-guided biliary stent placement and GJ tube placement. EUS guided PD access and reconnection through the "parallel rendezvous" technique are used for treatment in this case.<br /><br />The document concludes that EUS-guided PD access for reconnection is an option for patients with duct disruption. However, it notes the limitations including the lack of dedicated EUS access devices and wires.

Keywords

ASGE

Case Western University

4th Year Advanced Endoscopy Fellows Program

Disconnected Pancreatic Duct Syndrome

DPDS

EUS-guided pancreatic duct access

minimally invasive approach

double pigtail stents

retrograde approach

duct disruption