Interventional Endoscopic Ultrasound (EUS) | October 2026-Tyberg

Tyberg_ASGE T-EUS Course- EUS-PD Drainage

Pdf Summary

EUS-guided pancreatic duct drainage (EUS-PD) is used to decompress an obstructed main pancreatic duct when drainage is needed and conventional ERCP is not feasible. Indications include recurrent acute pancreatitis, pancreatic fluid collections or fistulas, duct leaks or pancreatic ascites, and worsening pancreatic function. ERCP may be impossible because of tight strictures, obstructing stones, ampullary disease, gastric outlet obstruction, altered anatomy, or a disconnected duct.<br /><br />Evidence from multicenter studies and a meta-analysis reports technical success of about 89%, clinical success of 81–88%, and adverse events in approximately 17–20% of patients.<br /><br />The procedure involves identifying and puncturing the duct under EUS guidance, injecting contrast, securing wire access, creating a fistulous tract, and placing a decompression stent. When possible, the wire is advanced across the ampulla or anastomosis to enable rendezvous ERCP. Stent choice and placement depend on factors including duct size, access site, and whether drainage is antegrade, retrograde, or transpapillary/transanastomotic.<br /><br />Potential adverse events include post-procedure pain, pancreatitis, bleeding, perforation, duct leak, infection, and stent migration or occlusion; the latter may require unplanned intervention. Periprocedural care may include indomethacin, IV hydration, inpatient observation, and gradual diet advancement. Long-term follow-up should assess symptomatic and imaging improvement; routine stent exchange remains an open consideration.<br /><br />Key technical principles include finding a short, stable access route; avoiding calcifications and other structures; controlling needle depth; and allowing cautery to create the tract. If complications occur, stabilize the patient, consider conservative or endoscopic management, and monitor closely.

Keywords

EUS-guided pancreatic duct drainage

EUS-PD

obstructed main pancreatic duct

ERCP not feasible

recurrent acute pancreatitis

pancreatic fluid collections

duct leaks

pancreatic ascites

technical success

adverse events