Endoscopic ultrasonography-guided pancreaticogastrostomy for a case of occlusion of gastro-pancreatic anastomosis after pancreaticoduodenectomy.

Background: EUS-guided pancreaticogastrostomy is described as an alternative to surgery for ductal decompression when endoscopic transpapillary access is impossible. We report a case where EUS-guided pancreaticogastrostomy of the pancreatic duct was effective for dilatation of the pancreatic duct caused from occlusion of gastro-pancreatic anastomosis constructed after resection of pancreaticoduodenectomy. Patients and methods: The patient was a 79-year-old woman who had undergone operation for IPMN in the pancreatic head in 1998. Nine years after the operation, she visited us for back pain, and conspicuous dilatation of the main pancreatic duct was found. By observing curved liner array EUS scope, we successfully punctured the main pancreatic duct and placed a plastic stent. Results: After the treatment, the subjective symptom was alleviated and reduction of the dilatation of pancreatic duct was observed in image findings. Conclusion: Endoscopic ultrasonography guided pancreaticogastrostomy appears to be an effective treatment for a case of occlusion of gastro-pancreatic anastomosis after pancreaticoduodenectomy.