Amy Tyberg, MD, from the Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, in New York, New York, USA presents this video case “EUS-guided pancreatic drainage for recurrent pancreatitis.”

This case describes a 71-year-old female with recurrent pancreatitis and a tight pancreatic duct (PD) stricture that was unable to be crossed during conventional ERCP. Endoscopic ultrasound-guided PD drainage (EUS-PD) was performed with successful antegrade trangastric stent placement and subsequent PD decompression. Repeat conventional ERCP was then performed with successful crossing of the stricture and transpapillary stent placement.

EUS-PD has emerged as a safe and efficacious alternative to surgical intervention in patients who fail conventional ERCP for PD decompression. This technique involves accessing the PD using EUS, creating a fistulous tract, and deploying a drainage stent. The stent is placed in a transpapillary orientation whenever feasible; however, in cases where the wire is unable to be advanced across the ampulla, an antegrade transgastric or transenteric stent placement is placed. Traditionally, the antegrade stent is left in place indefinitely to allow for continued PD decompression post-procedure.

In this case, conventional ERCP was repeated several weeks after EUS-PD. During the repeat procedure, the stricture was able to be crossed with a standard guidewire, and a retrograde transpapillary stent was able to be deployed across the stricture with removal of the previously placed antegrade transgastric stent. This demonstrates that conventional ERCP can be successfully performed, even in cases of previously failed ERCP, after PD decompression using EUS-PD technique.

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