Interventional Endoscopic Ultrasound (EUS) (on demand)-Pancreatic Duct Drainage

Video Transcription

Video Summary

Dr. Amy Tiberg reviewed EUS-guided pancreatic duct (PD) drainage, a technically challenging procedure reserved for patients with obstructed ducts who need drainage when conventional ERCP is unsuccessful or impossible. Causes include tight strictures, stones, altered anatomy, and disconnected ducts. The procedure involves EUS-guided duct puncture, pancreatography, wire access, and either a rendezvous approach or creation of a fistula for stent placement. Choice of access route and stent direction depends on anatomy; crossing the ampulla or anastomosis is preferred when feasible.<br /><br />The evidence comes mainly from multicenter studies, with good but imperfect success rates and relatively high adverse-event risk. Tiberg commonly uses cautery to create the tract, then dilates and places a double-pigtail plastic stent, often starting at 7 Fr. Stent exchange practices vary, with no consensus on the best approach.<br /><br />Discussion emphasized careful patient selection: duct dilation alone, worsening diabetes, or enzyme-treated insufficiency may not justify the risk without pain or recurrent pancreatitis. Key technical advice included finding a stable, safe window, avoiding calcifications, undershooting the duct during puncture, and letting cautery—not force—create the tract. If complications occur, remain calm, stabilize the patient, regroup, and arrange close follow-up.

Asset Subtitle

Amy Tyberg, MD, FASGE

Meta Tag

Concept Endoscopic Ultrasound-Guided Pancreatic Duct Drainage

Concept Complete Pancreatic Duct Obstruction

Concept Recurrent Pancreatitis

Concept Altered Anatomy

Concept ERCP Failure

Keywords

EUS-guided pancreatic duct drainage

obstructed pancreatic duct

ERCP failure

pancreatic duct stent

pancreatography

rendezvous approach

adverse events

pancreatic duct obstruction

pancreatic stent placement

cautery tract creation

patient selection