The advancement of pancreatic endotherapy has increased the availability of minimally invasive endoscopic pancreatic ductal drainage techniques. In this regard, familiarity with endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is critical for treatment of obstructed pancreatic ductal systems, especially in nonsurgical candidates and in patients desiring a minimally invasive approach. Two distinct forms of EUS-PDD exist, viz. rendezvous-assisted endoscopic retrograde pancreatography (rendezvous-assisted ERP) and anterograde EUS-PDD. Anterograde EUS-PDD refers to transmural anterograde passage of a pancreatic drainage catheter or stent directly into the main pancreatic duct, through either the gastric or enteral wall. Rendezvous-assisted ERP should be attempted after failed conventional ERP, and anterograde EUS-PDD should be considered if rendezvous-assisted ERP fails or is not technically feasible. Common clinical scenarios that fulfil these conditions are chronic pancreatitis with high-grade main pancreatic duct obstruction, surgically altered anatomy with ductal/anastomotic obstruction, pancreas divisum, and disconnected pancreatic duct syndrome. The focus of this review article is anterograde EUS-PDD and its indications, technique, and outcomes. It also provides a summary of our own experience with this procedure, and a video demonstration of the technique.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Chen YI, Levy MJ, Moreels TG, et al. An international multicenter study comparing EUS-guided pancreatic duct drainage with enteroscopy-assisted endoscopic retrograde pancreatography after Whipple surgery. Gastrointest Endosc. 2017;85:170–177.
Kurihara T, Itoi T, Sofuni A, Itokawa F, Moriyasu F. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc. 2013;25:109–116.
Fujii LL, Topazian MD, Abu Dayyeh BK, et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc. 2013;78:854–864.
Ahmed Ali U, Pahlplatz JM, Nealon WH, van Goor H, Gooszen HG, Boermeester MA. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev. 2015:CD007884.
Brauer BC, Chen YK, Fukami N, Shah RJ. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc. 2009;70:471–479.
Mizandari M, Azrumelashvili T, Kumar J, Habib N. Percutaneous image-guided pancreatic duct drainage: technique, results and expected benefits. Cardiovasc Intervent Radiol. 2017;40:1911–1920.
Dumonceau JM, Costamagna G, Tringali A, et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut. 2007;56:545–552.
Chandrasekhara V, Chathadi KV, Acosta RD, et al. The role of endoscopy in benign pancreatic disease. Gastrointest Endosc. 2015;82:203–214.
Oh D, Park DH, Cho MK, et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc. 2016;83:e362.
Shimamura Y, Mosko J, Teshima C, May GR. Endoscopic ultrasound-guided pancreatic duct intervention. Clin Endosc. 2017;50:112–116.
Siddiqui UD, Levy MJ. EUS-guided transluminal interventions. Gastroenterology. 2018;154:1911–1924.
François E, Kahaleh M, Giovannini M, Matos C, Devière J. EUS-guided pancreaticogastrostomy. Gastrointest Endosc. 2002;56:128–133.
Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc. 2007;65:224–230.
Tessier G, Bories E, Arvanitakis M, et al. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc. 2007;65:233–241.
Ergun M, Aouattah T, Gillain C, Gigot JF, Hubert C, Deprez PH. Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy. 2011;43:518–525.
Shah JN, Marson F, Weilert F, et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc. 2012;75:56–64.
Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc. 2012;76:1133–1141.
Will U, Reichel A, Fueldner F, Meyer F. Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. World J Gastroenterol. 2015;21:13140–13151.
Tyberg A, Sharaiha RZ, Kedia P, et al. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study. Gastrointest Endosc. 2017;85:164–169.
Anderson MA, Akshintala V, Albers KM, et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatology. 2016;16:83–94.
Reber HA, Karanjia ND, Alvarez C, et al. Pancreatic blood flow in cats with chronic pancreatitis. Gastroenterology. 1992;103:652–659.
Karanjia ND, Singh SM, Widdison AL, Lutrin FJ, Reber HA. Pancreatic ductal and interstitial pressures in cats with chronic pancreatitis. Dig Dis Sci. 1992;37:268–273.
Hobbs PM, Johnson WG, Graham DY. Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes. World J Gastrointest Pharmacol Ther. 2016;7:370–386.
Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2012;44:784–800.
Renou C, Grandval P, Ville E, Laugier R. Endoscopic treatment of the main pancreatic duct: correlations among morphology, manometry, and clinical follow-up. Int J Pancreatol. 2000;27:143–149.
Wilcox CM, Yadav D, Ye T, et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clin Gastroenterol Hepatol. 2015;13:552–560.
Rösch T, Daniel S, Scholz M, et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy. 2002;34:765–771.
Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J. 2017;5:153–199.
Dumonceau JM, Devière J, Le Moine O, et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc. 1996;43:547–555.
Delhaye M, Arvanitakis M, Verset G, Cremer M, Devière J. Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clin Gastroenterol Hepatol. 2004;2:1096–1106.
Farnbacher MJ, Mühldorfer S, Wehler M. Interventional endoscopic therapy in chronic pancreatitis including temporary stenting: a definitive treatment? Scand J Gastroenterol. 2006;41:111–117.
Tadenuma H, Ishihara T, Yamaguchi T, et al. Long-term results of extracorporeal shockwave lithotripsy and endoscopic therapy for pancreatic stones. Clin Gastroenterol Hepatol. 2005;3:1128–1135.
Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg. 1958;76:898–907.
Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2:701–707.
Beger HG, Witte C, Krautzberger W. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg. 1980;51:303–307.
Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet. 2017;390:1027–1037.
Traverso LW, Longmire WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146:959–962.
Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg. 2007;11:1704–1711.
Morgan KA, Fontenot BB, Harvey NR, Adams DB. Revision of anastomotic stenosis after pancreatic head resection for chronic pancreatitis: is it futile? HPB (Oxford). 2010;12:211–216.
Demirjian AN, Kent TS, Callery MP, Vollmer CM. The inconsistent nature of symptomatic pancreatico-jejunostomy anastomotic strictures. HPB (Oxford). 2010;12:482–487.
Chahal P, Baron TH, Topazian MD, Petersen BT, Levy MJ, Gostout CJ. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy. 2006;38:1241–1245.
Fujii-Lau LL, Levy MJ. Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Pancreat Sci. 2015;22:51–57.
Itoi T, Kasuya K, Sofuni A, et al. Endoscopic ultrasonography-guided pancreatic duct access: techniques and literature review of pancreatography, transmural drainage and rendezvous techniques. Dig Endosc. 2013;25:241–252.
Conflict of interest
Drs. Matthew Krafft and John Nasr report no disclosures related to industry.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Step-by-step video, with narration, of anterograde EUS-PDD. This video was made during the index procedure for case (patient) number 1, shown in Table 2 (MP4 131,466 kb)
About this article
Cite this article
Krafft, M.R., Nasr, J.Y. Anterograde Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: A Technical Review. Dig Dis Sci 64, 1770–1781 (2019). https://doi.org/10.1007/s10620-019-05495-9
- Anterograde endoscopic ultrasound-guided pancreatic duct drainage
- Endoscopic ultrasound
- Chronic pancreatitis
- Disconnected pancreatic duct syndrome