Post written by Shigenobu Yoshimura, MD, from the Department of Gastroenterology, Kameda Medical Center, Chiba, Japan.

This video case shows an endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) using transduodenal puncture sites performed for malignant pancreatic duct obstruction. We performed EUS-PD from the long position with a forward-viewing (FV) echoendoscope.

EUS-PD has emerged as a feasible alternative to failed conventional methods of endoscopic retrograde pancreatography. It has high technical and clinical success rates; however, the rate of associated adverse events is also high. Its safety should be improved. There are 2 puncture sites for EUS-PD, including transgastric and transduodenal puncture sites. Most previous studies used the transgastric route; however, the transduodenal approach from the long position might allow a better view of the main pancreatic duct for puncture. Moreover, a long position allows better stability and stent pushability and less susceptibility to respiratory fluctuations during the procedure. Therefore, we think that pancreaticoduodenostomy with an FV echoendoscope might improve the stability of the procedure.

 We hope that this procedure will be useful as one of the treatment options that can contribute to improving the safety of EUS-PD.

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