Transjejunal endoscopic ultrasound‐guided pancreatic drainage for pancreatic jejunostomy stricture using a forward‐viewing echoendoscope in a patient with altered anatomy
Hiroshi Shimizu,
Rei Suzuki,
Yuki Sato,
Tadayuki Takagi,
Naoto Abe,
Hiroki Irie,
Mitsuru Sugimoto,
Takumi Yanagita,
Ryoichiro Kobashi,
Minami Hashimoto,
Tsunetaka Kato,
Mika Takasumi,
Jun Nakamura,
Takuto Hikichi,
Hiromasa Ohira
Affiliations
Hiroshi Shimizu
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Rei Suzuki
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Yuki Sato
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Tadayuki Takagi
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Naoto Abe
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Hiroki Irie
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Mitsuru Sugimoto
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Takumi Yanagita
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Ryoichiro Kobashi
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
Minami Hashimoto
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
Tsunetaka Kato
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
Mika Takasumi
Department of Gastroenterology Fukushima Medical University Fukushima Japan
Jun Nakamura
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
Takuto Hikichi
Department of Endoscopy Fukushima Medical University Hospital Fukushima Japan
Hiromasa Ohira
Department of Gastroenterology Fukushima Medical University Fukushima Japan
ABSTRACT Pancreatic jejunostomy stricture (PJS) is one of the major late complications after pancreaticoduodenectomy. Endoscopic ultrasound‐guided pancreatic drainage (EUS‐PD) is considered a salvage treatment for symptomatic PJS after endoscopic retrograde pancreatography failure; however, the technical success rate of the endoscopic treatment of PJS remains unsatisfactory, mainly due to surgically altered anatomy. Herein, we describe a case of PJS successfully treated with transjejunal EUS‐PD using a forward‐viewing echoendoscope. A 62‐year‐old man who suffered from repetitive severe back pain due to PJS was referred to our hospital. Since transgastric EUS‐PD was difficult, we attempted transjejunal EUS‐PD using a forward‐viewing echoendoscope. To facilitate scope insertion, we first straightened the afferent jejunal loop and placed a stiff guidewire. With this scheme, we successfully performed transjejunal EUS‐PD and placed a 5‐Fr plastic stent. In conclusion, this technique is useful for treating patients with PJS when transgastric EUS‐PD is difficult.
