Published online Aug 21, 2013. doi: 10.3748/wjg.v19.i31.5182
Revised: June 2, 2013
Accepted: June 19, 2013
Published online: August 21, 2013
The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7. Thereafter, she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy. She developed a pancreatic fistula and an intra-abdominal abscess after the operation. These complications were improved by percutaneous abscess drainage and antibiotic therapy. However, upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy. Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography, we tried an endoscopic ultrasonography (EUS) guided rendezvous technique for pancreatic duct drainage. After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle, the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis. We changed the echoendoscope to an oblique-viewing endoscope, then grasped the guidewire and withdrew it through the scope. The stenosis of the pancreaticojejunostomy was dilated up to 4 mm, and a pancreatic stent was put in place. Though the pancreatic stent was removed after three months, the patient remained symptom-free. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.
Core tip: The usefulness of pancreatic duct drainage using endoscopic ultrasonography-guided rendezvous technique for stenotic pancreaticojejunostomy after pancreaticoduodenectomy. However, this procedure requires technically skill and the success rate is low. The main reason for failure is the inability to pass through the stenotic anastomosis due to its tightness. In our case, the stenosis was not so tight because the stenosis developed about a month after the operation. A case of stenotic pancreaticojejunostomy that occurs at any early stage after pancreaticoduodenectomy with a dilated pancreatic duct is possibly a good indication.