Makazu M, Koizumi K, Kubota J, Kimura K, Masuda S. Transpapillary drainage of pancreatic fluid leakage via a rigid trans-tumoral tract using a drill dilator: A case report. World J Gastrointest Endosc 2025; 17(9): 110424 [DOI: 10.4253/wjge.v17.i9.110424]
Corresponding Author of This Article
Makomo Makazu, MD, PhD, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan. m_makazu@shonankamakura.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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. Sep 16, 2025; 17(9): 110424 Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.110424
Transpapillary drainage of pancreatic fluid leakage via a rigid trans-tumoral tract using a drill dilator: A case report
Makomo Makazu, Kazuya Koizumi, Jun Kubota, Karen Kimura, Sakue Masuda
Makomo Makazu, Kazuya Koizumi, Jun Kubota, Karen Kimura, Sakue Masuda, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Author contributions: All authors contributed to the study conception and design; the first draft of the manuscript was written by Makazu M; Koizumi K, Kubota J, Kimura K, and Masuda S commented on the subsequent versions of the manuscript and read and approved the final manuscript.
Informed consent statement: The patient provided written informed consent for publication of her details.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Makomo Makazu, MD, PhD, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan. m_makazu@shonankamakura.or.jp
Received: June 10, 2025 Revised: July 2, 2025 Accepted: August 5, 2025 Published online: September 16, 2025 Processing time: 97 Days and 6.9 Hours
Abstract
BACKGROUND
Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails. Endoscopic, percutaneous, and surgical drainage are options. Minimally invasive endoscopic procedures are generally considered the first-line treatment, with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case. Various dilators are used to dilate tracts to the leakage site. However, reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.
CASE SUMMARY
A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy. Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion. The effusion was diagnosed as reactive secondary to pancreatic fluid leakage. Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body. Distal to the stenosis, the main ductal structure was nearly obliterated by the tumor. The contrast medium had leaked into the pancreatic fluid leakage area through several fine, disrupted ductal structures. The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route. Standard dilators failed to expand the rigid trans-tumoral tract. A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract, enabling endoscopic nasopancreatic drainage tube placement. Subsequently, the pancreatic fluid leakage and pleural effusion resolved.
CONCLUSION
Even in rigid trans-tumoral tracts, the use of a drill dilator can facilitate successful tract expansion, enabling effective drainage.
Core Tip: We encountered a case of pancreatic fluid leakage with reactive left pleural effusion associated with pancreatic cancer. The guidewire traversed a relatively long distance through the tumor to reach the leakage site. Expanding this rigid tract was challenging with conventional dilators but was successfully achieved using a drill dilator. Placement of a drainage tube led to the resolution of both the pancreatic fluid leakage and reactive pleural effusion. When conventional or balloon dilators fail to expand the stenotic tract, a drill dilator may facilitate successful passage through the stricture.
