Endoscopic Ultrasound-Guided Pancreatography: A Case Report

Abstract

Endoscopic ultrasound-guided pancreatography was performed on a 48-year-old man with a diagnosis of pancreatic stone. A pylorus-preserving pancreaticoduodenectomy had been performed previously on this patient, approximately two years earlier, following the diagnosis of a tumor-forming pancreatitis. Endoscopic retrograde pancreatography and conventional ultrasound-guided percutaneous pancreatography had failed to yield a diagnosis. However, endoscopic ultrasound-guided pancreatography was performed successfully, delineating the pancreatic duct and a filling defect caused by intraductal calculi. Endoscopic ultrasound-guided pancreatography will be a potential alternative in cases when endoscopic retrograde pancreatography has failed or proved non-diagnostic.

Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP

“…[2][3][4] The technique for EUS-guided rendezvous for transpapillary duct access was first described in a case report by Bataille and Deprez 5 in 2002. Alternatively, EUSguided injection of a mixture of contrast material and methylene blue (MB) into the PD may help to identify the minor and major papilla orifices.…”

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“…When ERP fails or surgical intervention is not feasible, alternative techniques are required. EUS-guided pancreatography was first described in a patient with a symptomatic pancreatic duct stone after pancreaticoduodenectomy [313], followed by a few further reports describing EUS-guided access and interventions of the main pancreatic duct [171,314].…”

Therapeutic Endoscopic Ultrasound for Biliary and Pancreatic Disorders

“…The first reported EUS-guided pancreatography was documented by Harada [28] in 1995, and involved a patient requiring removal of a main pancreatic duct stone following pancreaticoduodenectomy. Other reports soon followed [17,29].…”