Antegrade pancreatoscopy via EUS-guided pancreaticogastrostomy allows removal of obstructive pancreatic duct stones

BACKGROUND AND STUDY AIMS : Endoscopic retrograde cholangiopancreatography (ERCP) is an effective treatment for pancreaticolithiasis, including use of pancreatoscopy for intraductal electrohydraulic lithotripsy (IEHL). Pancreatoscopy is often limited by a small-caliber downstream pancreatic duct as well as an unstable pancreatoscope position within the pancreatic head. Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PG) has been developed as a method to relieve ductal obstruction when retrograde access fails. The current study describes pancreatoscopy via EUS-PG, a novel method for managing obstructing pancreaticolithiasis. PATIENTS AND METHODS : From September 2017 to January 2018, patients who underwent EUS-PG followed by antegrade pancreatoscopy via PG were identified. Endoscopy reports, medical charts and relevant laboratory data were reviewed and recorded. RESULTS : Five patients underwent EUS-PG and antegrade pancreatoscopy via PG during the study period; clinical success rate was 100 %. There were no significant adverse events during the procedure or follow up period. CONCLUSIONS : Pancreatoscopy via PG for IEHL is safe and effective for treating obstructing pancreaticolithiasis in patients who have previously failed ERCP or in clinical scenarios were ERCP is not possible.