Successful Endoscopic Treatment of Severe Pancreaticojejunostomy Strictures by Puncturing the Anastomotic Site with an EUS-guided Guidewire

Intern Med. 2018 Feb 1;57(3):357-362. doi: 10.2169/internalmedicine.9133-17. Epub 2017 Nov 20.

Abstract

Pancreaticojejunostomy stricture (PJS) is a late complication of pancreaticoduodenectomy. The endoscopic treatment of PJS is very challenging due to the difficulty of locating the small anastomotic site and passing the stricture using a guidewire. We herein report two cases of severe PJS. These patients could not be treated using only double-balloon endoscopy or endoscopic ultrasound-guided puncture of the main pancreatic duct because of severe stenosis at the anastomotic site. However, we could treat them by the rendezvous technique using the rigid part of the guidewire to penetrate PJS. This method was useful and safe for treating severe PJS.

Keywords: endoscopic ultrasound; late complication; pancreaticoduodenectomy; pancreaticojejunostomy stricture; rendezvous technique.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Constriction, Pathologic / diagnostic imaging
  • Constriction, Pathologic / etiology*
  • Constriction, Pathologic / surgery*
  • Endoscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Ducts / diagnostic imaging*
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / methods
  • Pancreaticojejunostomy / adverse effects*
  • Punctures
  • Treatment Outcome
  • Young Adult