Wang SY, Zhao SQ, Wang SP, Zhang Y, Sun SY, Wang S. Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook. World J Gastrointest Surg 2025; 17(5): 104267 [DOI: 10.4240/wjgs.v17.i5.104267]
Corresponding Author of This Article
Sheng Wang, MD, Chief Physician, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. wangs@sj-hospital.org
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Si-Yao Wang, Yue Zhang, Si-Yu Sun, Sheng Wang, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Si-Qiao Zhao, Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Shu-Peng Wang, Department of Gastroenterology, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Co-corresponding authors: Si-Yu Sun and Sheng Wang.
Author contributions: Wang SY and Wang S conceptualized and designed the research; Zhao SQ acquired clinical data from patients; Wang SY and Zhang Y jointly reviewed the literature on EUS-PD and related comparative techniques, particularly from the past five years; Wang SY and Wang SP completed the figure preparation; Wang SY, Wang S, and Sun SY wrote the manuscript. All authors have read and approved the final version. Wang S and Sun SY, as co-corresponding authors, contributed equally to guiding the experimental design, data interpretation, and manuscript preparation. Specific roles are outlined below: Wang S contributed to conceptualized and designed the overall framework of the study, secured funding, and supervised the entire research process. Wang S led the initial literature review, focusing on the differences in complications and survival rates between EUS-PD and surgical interventions, and assisted in drafting the manuscript. Sun SY contributed to oversaw manuscript revisions, emphasizing standardized training for clinicians in EUS-PD techniques and its future prospects, and finalized the manuscript for submission. The complementary collaboration between Wang S and Sun SY was pivotal to the successful completion of this study and its subsequent outcomes.
Supported by the Liaoning Provincial Science and Technology Plan Joint Program (Applied Basic Research Project), Undertaken by Shengjing Hospital of China Medical University in Collaboration with China Resources Health (Liaoning) Group Co., Ltd., No. 2023JHZ/101700190.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng Wang, MD, Chief Physician, Professor, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. wangs@sj-hospital.org
Received: December 16, 2024 Revised: February 28, 2025 Accepted: April 2, 2025 Published online: May 27, 2025 Processing time: 157 Days and 16.1 Hours
Abstract
As an innovative endoscopic intervention, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) demonstrates significant clinical value in resolving pancreatic ductal hypertension syndrome. By integrating real-time ultrasound guidance with catheter-based intervention techniques, this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed. Current evidence indicates that EUS-PD achieves technical success rates ranging from 82% to 95% in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures, with an overall complication rate (15%-20%) substantially lower than surgical interventions. Compared to conventional imaging modalities, EUS-PD offers superior anatomical visualization capabilities: Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches, while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures (sensitivity 91% vs 73%, P < 0.05). Nevertheless, technical challenges persist, including difficult ductal puncture localization (particularly in pancreatic head lesions), complex guidewire axial control, and postoperative pancreatic fistula risks (7%-12%). This review systematically examines the clinical indications/contraindications, procedural protocols, device selection criteria, and management strategies for early/late complications associated with EUS-PD. Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches. Advancements in auxiliary technologies (e.g., three-dimensional elastography, AI-assisted navigation) and multidisciplinary team collaboration are pivotal to developing standardized protocols. We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems. Such initiatives will facilitate the clinical transformation of EUS-PD from an "alternative option" to a "preferred strategy", ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.
Core Tip: Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) is an emerging therapeutic technique used to relieve symptoms caused by pancreatic duct obstruction and high pressure. It provides an effective alternative for cases where endoscopic retrograde pancreatography has failed. This review summarizes the latest research advancements and key procedural considerations of EUS-PD, offering practical guidance for clinicians.
