EUS-Guided Pancreatic Duct Drainage

EUS-Guided Pancreatic Duct Drainage

Manuel Perez-Miranda, MD, PhD

Endoscopic ultrasound (EUS)-guided pancreatic duct drainage (EUS-PD) is a second-line procedure that allows drainage of the pancreatic duct when ERCP, the primary endoscopic procedure for pancreatic duct drainage, is either not feasible or unsuccessful.1 EUS-PD is performed in the fluoroscopy room by an experienced operator assisted by well-trained personnel in properly sedated and monitored patients at a facility with multidisciplinary backup. The availability of appropriate equipment and a wide array of devices cannot be overemphasized. EUS-PD complements pancreatic ERCP making endotherapy available to complex patients who would otherwise have to undergo surgery or percutaneous procedures for duct decompression or would have to face the suboptimal prospect of medical treatment. Depending on patient anatomy, operator expertise, and predictability of ERCP difficulty, EUS-PD can be performed within the same session of failed ERCP.2 Alternatively, EUS-PD can be scheduled in the future. Following transgastric or transduodenal EUS-guided pancreatography, drainage is established by means of transmural, transpapillary (either retrograde or antegrade), or a combined approach.1,2 A successful index EUS-PD may need follow-up procedures for stent revision, which no longer require an EUS endoscope.3


  • 1. Patient evaluation and consent: Thorough clinical evaluation, including cross-sectional imaging and MRI pancreatography (ideally with IV secretin), is essential to establish the indication and to define procedural approach. Depending on anticipated likelihood of ERCP failure and on institutional policy, informed consent is obtained for both ERCP and EUS-PD.

  • 2. Periprocedural medications: Antiplatelet/anticoagulation agents and antibiotic prophylaxis should be managed per American Society for Gastrointestinal Endoscopy guidelines.7
    The value of rectal nonsteroidal anti-inflammatory drugs and of intravenous hydration in decreasing the risk of postprocedural pancreatitis has not been established for EUS-PD, but are reasonable to consider.

  • 3. Sedation: The level of sedation required for EUS-PD is comparable to that of complexity level IV ERCP. Monitored anesthesia care or general endotracheal intubation are most common in the United States; however, nurse- or endoscopist-administered propofol can also be used to provide optimal sedation.

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on EUS-Guided Pancreatic Duct Drainage

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