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Gastrointest Endosc. 2017 Jan;85(1):170-177. doi: 10.1016/j.gie.2016.07.031. Epub 2016 Jul 25.

An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery.

Author information

1
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
2
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
3
Division of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
4
Division of Gastroenterology and Hepatology, Municipal Hospital, Gera, Germany.
5
Department of Surgery, Ana Costa Hospital, Santos, Brazil.
6
Division of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
7
Divisions of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka, Japan.

Abstract

BACKGROUND AND AIMS:

Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy.

METHODS:

This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included.

RESULTS:

In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P < .001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P < .001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P < .001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups.

CONCLUSIONS:

EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available.

PMID:
27460390
DOI:
10.1016/j.gie.2016.07.031
[Indexed for MEDLINE]

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