| Background: Endoscopic treatment of pancreatic diseases in patients with surgically-altered anatomy is technically challenging. Methods: We conducted a retrospective study to evaluate feasibility and effectiveness of management of pancreatic diseases using double-balloon endoscope (DBE)-assisted and/or endoscopic ultrasonography (EUS)-guided interventions. Our algorithm was DBE-assisted ERP (DB-ERP) first and EUS-guided pancreatic duct drainage (EUS-PD) after failed DBE. Results: A total of 39 patients underwent 37 DB-ERP and 9 EUS-PD between October 2006 and February 2019 including 30 pancreaticojejunal anastomotic stricture (PJAS), 15 pancreatic duct stone (PDS), and 7 pancreatic fistula (PF). Prior surgical reconstruction was the Billroth-II, Roux-en-Y methods, and others in 25, 12, and 2 patients. Two patients underwent primary EUS-PD and the remaining 7 underwent EUS-PD after failed DB-ERP (1 failed scope insertion and 6 failed cannulation). Technical success rates of DB-ERP and EUS-PD were 73.0% and 100% , respectively. Overall, resolution of PJAS, complete removal of PDS, and resolution of PF were achieved in 58.6%, 64.3%, and 28.5%, respectively. Adverse event rates were 13.5% (4 pancreatitis and 1 intestinal perforation) and 55.6% (3 pancreatic leakage and 2 abdominal pain). Conclusion: Endoscopic intervention for pancreatic diseases in patients with surgically-altered anatomy was feasible and effective, and should be considered as a first-line treatment option. However, EUS-PD was associated with relatively high adverse event rates and further improvement is mandatory. |
