Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent: A case report

Ki-Hyun Kim; Chang Hwan Park; Eunae Cho; Yohan Lee

doi:10.12998/wjcc.v12.i9.1677

Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent: A case report

World J Clin Cases. 2024 Mar 26;12(9):1677-1684. doi: 10.12998/wjcc.v12.i9.1677.

Authors

Ki-Hyun Kim¹, Chang Hwan Park², Eunae Cho¹, Yohan Lee¹

Affiliations

¹ Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea.
² Department of Gastroenterology, Chonnam National University Hospital, Gwangju 61469, South Korea. p1052ccy@hanmail.net.

Abstract

Background: Pancreatic ductal leaks complicated by endoscopic ultrasonography-guided tissue sampling (EUS-TS) can manifest as acute pancreatitis.

Case summary: A 63-year-old man presented with persistent abdominal pain and weight loss. Diagnosis: Laboratory findings revealed elevated carbohydrate antigen 19-9 (5920 U/mL) and carcinoembryonic antigen (23.7 ng/mL) levels. Magnetic resonance imaging of the pancreas revealed an approximately 3 cm ill-defined space-occupying lesion in the inferior aspect of the head, with severe encasement of the superior mesenteric artery. Pancreatic ductal adenocarcinoma was confirmed after pathological examination of specimens obtained by EUS-TS using the fanning method. Interventions and outcomes: The following day, the patient experienced severe abdominal pain with high amylase (265 U/L) and lipase (1173 U/L) levels. Computed tomography of the abdomen revealed edematous wall thickening of the second portion of the duodenum with adjacent fluid collections and a suspicious leak from either the distal common bile duct or the main pancreatic duct in the head. Endoscopic retrograde cholangiopancreatography revealed dye leakage in the head of the main pancreatic duct. Therefore, a 5F 7 cm linear plastic stent was deployed into the pancreatic duct to divert the pancreatic juice. The patient's abdominal pain improved immediately after pancreatic stent insertion, and amylase and lipase levels normalized within a week. Neoadjuvant chemotherapy was then initiated.

Conclusion: Using the fanning method in EUS-TS can inadvertently cause damage to the pancreatic duct and may lead to clinically significant pancreatitis. Placing a pancreatic stent may immediately resolve acute pancreatitis and shorten the waiting time for curative therapy. When using the fanning method during EUS-TS, ductal structures should be excluded to prevent pancreatic ductal leakage.

Keywords: Case report; Endoscopic ultrasound-guided tissue sampling; Pancreatic duct leak; Pancreatic stent; Pancreatitis.

Publication types

Case Reports