EUS-guided pancreatic duct drainage: ready for prime time?

It is very difficult to define today the place of EUS-guided pancreatic duct drainage; in our experience, the best indication is anastomotic The development of interventional EUS has provided better access to the region of the pancreas. Just as pancreatic fluid collections, such as pseudocysts, can be successfully drained from the stomach or duodenum by endoscopic cystenterostomy or cystgastrostomy, the same technique could be used to access a dilated pancreatic duct in cases in which the duct cannot be drained by conventional ERCP because of complete obstruction. The main indications are stenosis of pancreaticojejunal or pancreaticogastric anastomosis after Whipple resection, which induces recurrent acute pancreatitis (AP), main pancreatic duct (MPD) stenosis caused by chronic pancreatitis (CP), post-AP, or postpancreatic trauma after failure of ERCP. The pain associated with CP is caused, at least in part, by ductal hypertension. Both surgical and endoscopic treatments can relieve pain by improving ductal drainage. Endoscopic drainage requires transpapillary access to the pancreatic duct during ERCP. EUS-guided pancreaticogastrostomy or bulbostomy offers an alternative to surgery. stenosis after Whipple procedure for benign pancreatic lesions. TECHNICAL CONSIDERATIONS