Jagielski M, Bella E, Jackowski M. Endoscopic pancreatogastric anastomosis in the treatment of symptoms associated with inflammatory diseases of the pancreas. World J Gastrointest Endosc 2024; 16(7): 406-412 [PMID: 39072251 DOI: 10.4253/wjge.v16.i7.406]
Corresponding Author of This Article
Mateusz Jagielski, MD, PhD, Doctor, Lecturer, Professor, Surgeon, Department of General, Gastroenterological and Oncological Surgery, Nicolaus Copernicus University, Sw Jozef St 53-59, Toruń 87-100, Poland. matjagiel@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2024; 16(7): 406-412 Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.406
Endoscopic pancreatogastric anastomosis in the treatment of symptoms associated with inflammatory diseases of the pancreas
Mateusz Jagielski, Eryk Bella, Marek Jackowski
Mateusz Jagielski, Eryk Bella, Marek Jackowski, Department of General, Gastroenterological and Oncological Surgery, Nicolaus Copernicus University, Toruń 87-100, Poland
Author contributions: Jagielski M performed all the endoscopic procedures and wrote the manuscript; Bella E helped to design the study, did the research of similar studies and compared to them; Jackowski M did the final correct of the study and manuscript.
Institutional review board statement: The study was approved by the ethics committee of Collegium Medicum of Nicolaus Copernicus University (Toruń, Poland), No. KB 379/2023.
Informed consent statement: All patients gave informed consent for the proposed treatment and agreed to participate in the study.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mateusz Jagielski, MD, PhD, Doctor, Lecturer, Professor, Surgeon, Department of General, Gastroenterological and Oncological Surgery, Nicolaus Copernicus University, Sw Jozef St 53-59, Toruń 87-100, Poland. matjagiel@gmail.com
Received: February 27, 2024 Revised: May 22, 2024 Accepted: June 11, 2024 Published online: July 16, 2024 Processing time: 131 Days and 19.5 Hours
Abstract
BACKGROUND
The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases. The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP), which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract. However, in some patients, anatomical changes prevent transpapillary drainage of the main pancreatic duct. Surgery is the treatment of choice in such cases.
AIM
To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound (EUS) guidance.
METHODS
Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
RESULTS
In 9 patients [7 men, 2 women; mean age 53.45 (36-66) years], endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP. Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients (44.44%). Pancreatic fragmentation (disconnected pancreatic duct syndrome) was diagnosed in 3/9 patients (33.33%). In 2/9 patients (22.22%), narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy. Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients (88.89%). Endotherapeutic complications were observed in 2/9 patients (22.22%). Clinical success was achieved in 8/9 patients (88.89%). The mean follow-up period was 451 (42-988) d. Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients (77.78%).
CONCLUSION
Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method, especially in the absence of transpapillary access to the main pancreatic duct.
Core Tip: This study evaluated the effectiveness of an endoscopically created anastomosis between the stomach and main pancreatic duct for the treatment of chronic pain in the course of inflammatory diseases of the pancreas. If basic endoscopic treatment in the form of endoscopic retrograde cholangiopancreatography is ineffective or impossible to perform, creation of an anastomosis between the digestive tract and the pancreatic duct enables the effective treatment of chronic pain without the need for surgical intervention.
