EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study

Abstract Introduction Endoscopic retrograde pancreatography (ERP) is considered first-line therapy for management of symptomatic pancreatic duct obstruction. Technical failure with ERP occurs when the main pancreatic duct (MPD) cannot be cannulated. Endoscopic ultrasound (EUS) guided drainage of the PD is a minimally invasive alternative to surgery for failed conventional ERP. We present an international, multicenter study on the safety and efficacy of EUS-guided pancreatic drainage (EUS-PD) for patients who fail conventional endoscopic therapy. Methods Between January 2006 and December 2015, 80 patients underwent EUS-PD at 4 academic centers in 3 countries. Patient demographics, medical history, procedure data and follow up clinical data were collected. Technical success was defined as successful PD drainage with stent placement. Clinical success was defined as resolution or improvement of symptoms or improvement on post-procedure imaging. Results 80 patients (62.5% male, mean age 58.2 ± 15.5) were included. All patients had attempted ERP and/or extracorporeal lithotripsy if needed before EUS-PD. Technical success was achieved in 89% (n=71) of patients. Clinical success was achieved in 81% of patients overall (65/80) and in 92% of patients who achieved technical success (65/71). Immediate adverse events occurred in 20% (n=16) of patients and delayed AEs occurred in 11% (n=9). Discussion With appropriate endoscopic expertise, EUS-PD offers a minimally invasive, more effective, and safer alternative to some surgical pancreatic drainage procedures. Prospective studies are needed to evaluate long-term outcomes.