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Endoscopic Ultrasound-Guided Pancreaticogastrostomy in a Pediatric Patient

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Endoscopic Ultrasound-Guided Pancreaticogastrostomy in a Pediatric Patient E-Videos Endoscopic ultrasound-guided pancreaticogastrostomy in a pediatric patient A 14-year-old boy was admitted for acute was drained with a lumen-apposing metal Competing interests pancreatitis secondary to pancreas divi- stent (LAMS). Nevertheless, 1 month sum. The patient failed to improve with after successful pancreatic duct drain- M. Kahaleh has received research grants conservative management. In addition, age, the patient’s abdominal pain had from BSC, Xlumena, Cook, Olympus, Merit two separate conventional endoscopic resolved. Endotek, Aspire Bariatrics, GI Dynamics, retrograde cholangiopancreatographies Interventional EUS is a rapidly expanding Apollo, Fuji, Pentax, Emcision, Concordia, MI (ERCPs) were attempted for endoscopic field, and it has become a key technique Tech, Maunakea Tech, Ninepoint Medical, W.L. Gore, and the American Society for stenting for pancreas divisum. However in therapeutic endoscopy. It was initially Gastrointestinal Endoscopy (ASGE). both were unsuccessful in cannulation of described for the management of pan- the pancreatic duct despite secretin in- creatic fluid collections, but has expand- jection, spraying of the papilla with ed to include drainage of the biliary and The Authors methylene blue, and precut minor papil- pancreatic duct in the setting of failed lotomy. Despite pancreatic rest and nutri- conventional ERCP [1,2]. EUS-guided Monica Saumoy, Ming Ming Xu, Amy Tyberg, tional supplementation via percutaneous drainage should not be used to compen- Michel Kahaleh endoscopic gastrostomy (PEG) with jeju- sate for a lack of ERCP skills [3]. But if con- Division of Gastroenterology and Hepatology nal extension, the patient had persistent ventional drainage has been appropriate- New York Presbyterian Hospital, Weill, Cornell Medical College, New York, USA abdominal pain and back pain, as well as ly attempted and failed, rather than risk a failure to thrive. Therefore an endoscopic complication from ERCP, then EUS-guid- ultrasound (EUS)-guided pancreatico- ed drainage should be performed. We Corresponding author gastrostomy was performed for pancre- present the first reported case of EUS- ▶ atic duct drainage ( Video1). A 7-Fr × guided pancreaticogastrostomy in a pe- Michel Kahaleh, MD 15-cm plastic double-pigtail stent was diatric patient after failed ERCP for man- Division of Gastroenterology & Hepatology, placed in antegrade fashion, with the agement of pancreas divisum. Weill Cornell Medical College New York, NY proximal end in the stomach and the dis- 10021, USA tal end in the small intestine (▶ Fig.1). Endoscopy_UCTN_Code_CCL_1AF_2AZ_3AD Fax: +1-646-962-0110 The post-procedure course was compli- [email protected] cated by a peripancreatic collection that This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ▶ Fig.1 Fluoroscopic image of pancreati- Video 1 Failed pancreatic duct cannulation by conventional endoscopic retrograde cogastrostomy in a 14-year-old boy with cholangiopancreatography (ERCP) and successful endoscopic-ultrasound (EUS)-guided pancreas divisum, showing the double- pancreatic duct drainage in a 14-year-old boy with pancreas divisum. MRCP, magnetic res- pigtail plastic pancreatic duct drainage onance cholangiopancreatography; LAMS, lumen-apposing metal stent; PEG-J, percuta- stent as well as the previously placed bili- neous endoscopic gastrostomy (PEG) with jejunal extension; CBD, common bile duct; PD, ary stent and percutaneous endoscopic pancreatic duct. gastrostomy (PEG). Saumoy Monica et al. EUS-guided pancreaticogastrostomy in a pediatric patient … Endoscopy 2017; 49: E229–E230 E229 E-Videos References Bibliography DOI https://doi.org/10.1055/s-0043-113557 ENDOSCOPY E-VIDEOS Published online: 18.7.2017 [1] BaronTH. Endoscopic drainage of pancreatic https://eref.thieme.de/e-videos Endoscopy 2017; 49: E229–E230 fluid collections and pancreatic necrosis. © Georg Thieme Verlag KG Gastrointest Endosc Clin N Am 2003; 13: Endoscopy E-Videos is a free 743– 764 Stuttgart · New York access online section, reporting [2] Sharaiha RZ, Khan MA, Kamal F et al. Efficacy ISSN 0013-726X and safety of EUS-guided biliary drainage in on interesting cases and new comparison with percutaneous biliary techniques in gastroenterological drainage when ERCP fails: a systematic re- endoscopy. All papers include a high view and meta-analysis. Gastrointest Endosc quality video and all contributions are 2017; 85: 904– 914 freely accessible online. [3] Kahaleh M. Training the next generation of advanced endoscopists in EUS-guided bili- ary and pancreatic drainage: learning from This section has its own submission master endoscopists. Gastrointest Endosc website at – 2013; 78: 638 641 https://mc.manuscriptcentral.com/e-videos This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. E230 Saumoy Monica et al. EUS-guided pancreaticogastrostomy in a pediatric patient … Endoscopy 2017; 49: E229–E230.
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