An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery

Yen I. Chen, Michael J. Levy, Tom G. Moreels, Gulara Hajijeva, Uwe Will, Everson L. Artifon, Kazuo Hara, Masayuki Kitano, Mark Topazian, Barham Abu Dayyeh, Andreas Reichel, Tiago Vilela, Saowanee Ngamruengphong, Yamile Haito-Chavez, Majidah Bukhari, Patrick Okolo, Vivek Kumbhari, Amr Ismail, Mouen Khashab

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Background and Aims Endoscopic management of post-Whipple pancreatic adverse events (AEs) with enteroscopy-assisted endoscopic retrograde pancreatography (e-ERP) is associated with high failure rates. EUS-guided pancreatic duct drainage (EUS-PDD) has shown promising results; however, no comparative data have been done for these 2 modalities. The goal of this study is to compare EUS-PDD with e-ERP in terms of technical success (PDD through dilation/stent), clinical success (improvement/resolution of pancreatic-type symptoms), and AE rates in patients with post-Whipple anatomy. Methods This is an international multicenter comparative retrospective study at 7 tertiary centers (2 United States, 2 European, 2 Asian, and 1 South American). All consecutive patients who underwent EUS-PDD or e-ERP between January 2010 and August 2015 were included. Results In total, 66 patients (mean age, 57 years; 48% women) and 75 procedures were identified with 40 in EUS-PDD and 35 in e-ERP. Technical success was achieved in 92.5% of procedures in the EUS-PDD group compared with 20% of procedures in the e-ERP group (OR, 49.3; P <. 001). Clinical success (per patient) was attained in 87.5% of procedures in the EUS-PDD group compared with 23.1% in the e-ERP group (OR, 23.3; P <. 001). AEs occurred more commonly in the EUS-PDD group (35% vs 2.9%, P <. 001). However, all AEs were rated as mild or moderate. Procedure time and length of stay were not significantly different between the 2 groups. Conclusions EUS-PDD is superior to e-ERP in post-Whipple anatomy in terms of efficacy with acceptable safety. As such, EUS-PDD should be considered as a potential first-line treatment in post-pancreaticoduodenectomy anatomy when necessary expertise is available.

Original languageEnglish (US)
Pages (from-to)170-177
Number of pages8
JournalGastrointestinal Endoscopy
Issue number1
Publication statusPublished - Jan 1 2017


ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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