Eus-Pancreaticogastrostomy in a Patient with Subtotal Gastrectomy and Roux-En-Y Reconstruction

Mutignani Massimiliano, Dioscoridi Lorenzo*, Forti Edoardo, Pugliese Francesco and Manta Raffaele

Eus-Pancreaticogastrostomy in a Patient with Subtotal Gastrectomy and Roux-En-Y Reconstruction.

Chronic Pancreatitis is often associated with pain due to pancreatic duct obstruction. In these patients, surgical drainage was more effective than endoscopic treatment, achieving a faster, effective, and sustained pain relief. However, when surgery is not suitable,
different endoscopic procedures could be performed. Endoscopic drainage usually requires transpapillary access to the pancreatic duct during Endoscopic Retrograde Cholangio-Pancreatography.

The main limitation of endoscopic procedure is that the pancreatic duct
could not be accessible at ERCP because of Roux-en-Y reconstruction after gastric-pancreatic
surgery. Interventional Endoscopic Ultrasound may allow a successful drainage of a
dilated pancreatic duct, by using an endoscopic cysto-enterostomy followed by stent placement.

We described the EUS-pancreaticogastrostomy performed in a patient who underwent a subtotal gastrectomy complaining with chronic pancreatitis. In patients with severe chronic pancreatitis who previously underwent upper gastrointestinal surgery, endoscopic treatment could be an alternative to a surgical re-intervention.

Because of technical difficulties in performing the papillary approach in these patients, the use of EUS may easy allow a correct identification of the dilated pancreatic duct. We do not agree with the use of enteroscope because it does not allow the endoscopist to use large diameter stents.

Technical success of EUSguided pancreatic drainage was reported to range from 25% to 100%, with complications developing in 15% to 50% of patients. Most of technical failures were related to unsuccessful manipulation of the guidewire, whereas complications – mainly pancreatic leaks – depend on management of the transmural fistula.

Pancreas Open J. 2015; 1(1): 4-6. doi: 10.17140/POJ-1-102