Department of Gastroenterology and Hepatology, Tokyo Medical University
Background and Aims: Endoscopic ultrasonography（EUS）-guided pancreatic interventions have gained increasing attention. Acute recurrent pancreatitis can occur due to pancreatic duct obstruction from any cause. Recently, EUS-guided pancreatic duct stent placement has been used to treat such patients when traditional ERCP fails or is not possible due to post-surgical anatomy. In these previous reports and case series the mean technical success rate was only about 80％．Furthermore, adverse events such as pancreatic duct leaks, stent migration, and pancreatitis commonly occurred. Thus, we developed a new single pigtail plastic stent designed for EUS-guided pancreatic duct drainage（EUS-PD）and used as first-line. The aim of this study is to retrospectively evaluate the feasibility and efficacy of newly designed plastic stent. 【Methods】 Twenty-two patients with acute recurrent pancreatitis due to main pancreatic duct stricture or stenotic pancreatojejunostomy underwent EUS-PD. EUS-PD were performed using a 19-gauge or 22-gauge fine-needle. After tract dilation, new tapered tip and fourfold-flanged single pigtail plastic stent（7Fr, total length: 20-cm, effective length: 15-cm, flanges: 4 with apertures, side holes: total 12 holes, distal straight site, 4 holes and pigtail site, 8 holes）was placed. 【Results】 New plastic stent was placed successfully without procedural complication in all cases（22/22，100％）. Treatment success rate was 100％（22/22）. Self-limited abdominal pain was observed in 3 patients, bleeding in 1 patient 1 day postoperatively（IVR was needed）, and mild pancreatitis in 1 patient, but there were no stent migration. 【Conclusions】 A newly dedicated plastic stent which appears to be feasible and effective for EUS-PD.