Takao Itoi, MD, PhD, FASGE from the Tokyo Medical University in Tokyo, Japan shares his VideoGIE case “Tract dilation with a stent retrieval device in EUS-guided pancreatic duct stent placement.”
Endoscopic ultrasonography (EUS)-guided pancreatic duct (PD) stenting is always challenging. Apart from EUS-guided biliary drainage, it may be more difficult to dilate the needle tract unless a cautery dilator is used because penetration of the parenchyma of the pancreas by dilation catheter alone is an arduous task. In this report, we describe a successful case in which a Soehendra® stent retrieval device (SSD) was very effective in dilating the needle tract without a cautery dilator in a post-Whipple patient.
A 68-year-old man who had undergone Whipple resection 4 years prior to the procedure suffered from recurrent pancreatitis. Therefore, we performed EUS-guided pancreatic duct stenting. A 22-gauge needle was punctured into the PD (1.5 mm in diameter) and advanced a 0.018-inch stiff guidewire into the jejunum. Then, we used a 4-Fr tapered catheter to dilate the needle tract. However, the catheter did not advance into the PD. Therefore, we used an SSD to dilate the tract. Finally, the SSD was advanced into the PD and a transgastric 7-Fr PD stent was placed across the pancreatojejunostomy after both the needle tract and the pancreatojejunostomy site were dilated using a 4 mm dilating balloon without any complications. After the stent placement, the patient had no symptoms until 3 months after the procedure when we exchanged with a new stent as scheduled. At that time, there was no obvious evidence of pancreatic duct stricture.
In the USA, a 6F diameter cautery dilator is not commercially available. Instead, 10F Cystotome is available but is somehow too big and dangerous. Several endoscopists may use the needle knife over the guidewire instead as a cautery dilator. However, the cautery needle is not coaxial to the guidewire and can cause the unexpected adverse events like perforation or bleeding without correct tract dilation. Thus, wherever a 6F cautery dilator is not commercially available, SSD is one option for successful tract dilation in an EUS-guided procedure.
Watch the video online.
Figure 1. Fluoroscopic image of the Soehendra stent retrieval device advancing into the pancreatic duct.
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